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1,009 results on '"Cancer Prognostics and Health Outcomes Unit"'

1. Peri-operative mortality and long-term survival after partial versus radical cystectomy for muscle invasive bladder cancer

Author

None, Larcher, Alessandro; URI, Urological Research Institute, Division Of Oncology, Vita-Salute San Raffaele University, Milan, Italy, Sun, Maxine; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada, Schiffmann, Jonas; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany, Tian, Zhe; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada, Shariat, Shahrokh F.; Department of Urology, Medical University of Vienna, Vienna, Austria, McCormack, Michael; Department of Urology, University of Montreal Health Center, Montreal, Canada, Saad, Fred; Department of Urology, University of Montreal Health Center, Montreal, Canada, Buffi, Nicolò M.; Department of Urology, Humanitas Clinical and Research Center, Rozzano, MI, Italy, Briganti, Alberto; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Guazzoni, Giorgio; Department of Urology, Humanitas Clinical and Research Center, Rozzano, MI, Italy, Montorsi, Francesco; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Karakiewicz, Pierre I.; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada, None, Larcher, Alessandro; URI, Urological Research Institute, Division Of Oncology, Vita-Salute San Raffaele University, Milan, Italy, Sun, Maxine; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada, Schiffmann, Jonas; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany, Tian, Zhe; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada, Shariat, Shahrokh F.; Department of Urology, Medical University of Vienna, Vienna, Austria, McCormack, Michael; Department of Urology, University of Montreal Health Center, Montreal, Canada, Saad, Fred; Department of Urology, University of Montreal Health Center, Montreal, Canada, Buffi, Nicolò M.; Department of Urology, Humanitas Clinical and Research Center, Rozzano, MI, Italy, Briganti, Alberto; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Guazzoni, Giorgio; Department of Urology, Humanitas Clinical and Research Center, Rozzano, MI, Italy, Montorsi, Francesco; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, and Karakiewicz, Pierre I.; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

Abstract

Objective: The aim of the study was to compare partial cystectomy (PC) and radical cystectomy (RC) with respect to 90-day mortality as well as long-term, all cause (ACM) and cancer specific mortality (CSM).Methods: Using the SEER-Medicare database 3913 patients with T2-T3 urothelial carcinoma of the urinary bladder (UCUB) who underwent either RC (n = 3419) or PC (n = 494) were identified. After propensity score matching to reduce potential treatment selection bias, 90-day mortality, ACM-free and CSM-free rates between patients treated with PC and RC were estimated. Multivariable regression models (MVA) addressed 90-day mortality as well as 5-years ACM and CSM.Results: After matching, 33% (n = 494) and 67% (n = 988) patients treated respectively with PC or RC remained. Median follow-up was 26 months. The 90-day mortality rate was 3.2% (n = 16) after PC and 8.1% (n = 80) after RC (P = 0.001). In MVA, PC vs. RC was associated with a lower 90-day mortality (P < 0.001). At 5 years the ACM-free survival rate was 38% after PC and 40% after RC (P = 0.3) and failed to differ in MVA (P = 0.9). At 5 years the CSM-free survival rate was 59% after PC and 62% after RC (P = 0.2) and also failed to differ in MVA (P = 0.57). The same results were observed after restriction to patients with pT2N0 UCUB.Conclusions: Relative to RC, PC is associated with lower short-term mortality and the same long-term ACM and CSM rates. These observations should encourage greater consideration to PC in those selected cases when this type of surgery may be applied.

Published
2015

2. Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group

Author

Sunil Patel, Toshio Takagi, Andrew Tracey, Cosimo De Nunzio, Ali Abdel Raheem, Estefania Linares, Riccardo Autorino, Gaelle Fiard, Stephen Ryan, Nicola Pavan, Jean−Alexandre A. Long, Alessandro Antonelli, Bo Yang, Koon Ho Rha, Thomas Amiel, Carlotta Palumbo, Maria Carmen Mir, Simone Crivellaro, Alessandro Larcher, Luigi Schips, Riccardo Bertolo, Ahmet Bindayi, Carlo Trombetta, Chao Zhang, Francesco Montorsi, Tobias Maurer, Francesco Porpiglia, Umberto Capitanio, Estevão Lima, Ithaar Derweesh, Zachary Hamilton, Ryan W. Dobbs, Kazunari Tanabe, Antonio Celia, Joan Palou, Roberto Castellucci, Alberto Breda, Bindayi, A., Autorino, R., Capitanio, U., Pavan, N., Mir, M. C., Antonelli, A., Takagi, T., Bertolo, R., Maurer, T., Ho Rha, K., Long, J. -A., Yang, B., Schips, L., Lima, E., Breda, A., Linares, E., Celia, A., De Nunzio, C., Dobbs, R., Patel, S., Hamilton, Z., Tracey, A., Larcher, A., Trombetta, C., Palumbo, C., Tanabe, K., Amiel, T., Raheem, A., Fiard, G., Zhang, C., Castellucci, R., Palou, J., Ryan, S., Crivellaro, S., Montorsi, F., Porpiglia, F., Derweesh, I. H., Department of urology, Università Vita-Salute San Raffaele, Institute of Information Engineering [Beijing] (IIE), Chinese Academy of Sciences [Beijing] (CAS), Department of Urology, Medical University Graz, Sant'Andrea Hospital - Sapienza University of Rome, Cancer Prognostics and Health Outcomes Unit, Université de Montréal [Montréal], Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), China Agricultural University (CAU), servicio de urologia, Fundación Puigvert, Centre d'Études Biologiques de Chizé - UMR 7372 (CEBC), Institut National de la Recherche Agronomique (INRA)-Université de La Rochelle (ULR)-Centre National de la Recherche Scientifique (CNRS), Université de Montréal (UdeM), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and Université de La Rochelle (ULR)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)

Subjects
Male, Urologic Diseases, medicine.medical_specialty, Outcome Assessment, Urology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Renal function, Kidney, Nephrectomy, 03 medical and health sciences, Postoperative Complications, Text mining, 0302 clinical medicine, Elderly, Chronic Kidney Disease, medicine, Carcinoma, Humans, In patient, Stage (cooking), Trifecta, Survival analysis, Retrospective Studies, Aged, MESH: Carcinoma, Partial Nephrectomy, Renal Cell, Aged, 80 and over, business.industry, Renal surgery, Age Factors, Margins of Excision, renal carcinoma, medicine.disease, Kidney Neoplasms, 3. Good health, Surgery, Treatment Outcome, 030220 oncology & carcinogenesis, business, Glomerular Filtration Rate, Kidney disease
Abstract

Background: Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. Objective: To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. Design, setting, and participants: Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). Intervention: PN. Outcome measurements and statistical analysis: Primary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. Results and limitations: We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n = 264). Trifecta patients had less transfusion (p < 0.001), lower intraoperative (5.3% vs 27%, p < 0.001) and postoperative (25.4% vs 37.8%, p = 0.001) complications, shorter hospital stay (p = 0.045), and lower ΔeGFR (p < 0.001). MVA for predictive factors for trifecta revealed decreasing RENAL nephrometry score (odds ratio [OR] 1.26, 95% confidence interval 1.07–1.51, p = 0.007) as being associated with increased likelihood to achieve trifecta. Achievement of trifecta was associated with decreased risk of CKD upstaging (OR 0.47, 95% confidence interval 0.32–0.62, p < 0.001). KMA showed that trifecta patients had improved 5-yr freedom from CKD stage 3 (93.5% vs 57.7%, p < 0.001) and CKD upstaging (84.3% vs 8.2%, p < 0.001). Limitations include retrospective design. Conclusions: PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. Patient summary: We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation. Partial nephrectomy in elderly patients provides quality outcomes as measured by trifecta. Tumor complexity is a key determinant for trifecta achievement, and trifecta attainment is associated with improved function. Increasing utilization of robotics has benefits in recovery without compromising quality.

Published
2020

3. Association between lifetime alcohol consumption and prostate cancer risk: A case-control study in Montreal, Canada

Author

Pierre I. Karakiewicz, Claire Demoury, Marie-Élise Parent, Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), Department of Urology Université de Montréal, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), and Centre Hospitalier de l'Université de Montréal (CHUM)

Subjects
Adult, Male, Canada, Cancer Research, Alcohol Drinking, Etiology, Epidemiology, [SDV]Life Sciences [q-bio], Population, Lower risk, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Statistical significance, Statistics, Humans, Medicine, 030212 general & internal medicine, education, Early Detection of Cancer, Aged, education.field_of_study, Prostate cancer, business.industry, Confounding, Case-control study, Prostatic Neoplasms, Odds ratio, Middle Aged, Case-control, Confidence interval, Risk Estimate, Oncology, Case-Control Studies, 030220 oncology & carcinogenesis, Alcohol, business, Demography
Abstract

Background Alcohol intake may increase the risk of prostate cancer (PCa). Many previous studies harbored important methodological limitations. Methods We conducted a population-based case-control study of PCa comprising 1933 cases and 1994 controls in Montreal, Canada. Lifetime alcohol consumption was elicited, by type of beverage, during in-person interviews. Odds ratios (OR) and 95% confidence intervals (CI) assessed the association between alcohol intake and PCa risk, adjusting for potential confounders and considering the subjects’ PCa screening history. Results We observed a weak, non-significant positive association between high consumption of total alcohol over the lifetime and risk of high-grade PCa (OR = 1.18, 95% CI 0.81–1.73). Risk estimates were more pronounced among current drinkers (OR = 1.40, 95%CI 1.00–1.97), particularly after adjusting for the timing of last PCa screening (OR = 1.52, 95%CI 1.07–2.16). These associations were largely driven by beer consumption. The OR for high-grade PCa associated with high beer intake was 1.37 (95%CI 1.00–1.89); it was 1.49 (95%CI 0.99–2.23) among current drinkers and 1.68 (95% CI 1.10–2.57) after adjusting for screening recency. High cumulative consumption of spirits was associated with a lower risk of low-grade PCa (OR = 0.75, 95%CI 0.60–0.94) but the risk estimate no longer achieved statistical significance when restricting to current users. No association was found for wine consumption. Conclusion Findings add to the accumulating evidence that high alcohol consumption increases the risk of high-grade PCa. This association largely reflected beer intake in our population, and was strengthened when taking into account PCa screening history.

Published
2016

4. Convective Bubbly Flow of Water in an Annular Pipe: Role of Total Dissolved Solids on Heat Transfer Characteristics and Bubble Formation

Author

Mohammad Mohsen Sarafraz, Zhe Tian, Maziar Arjomandi, Mohammad Reza Safaei, Iskander Tlili, Mostafa Safdari Shadloo, Marjan Goodarzi, Tawfeeq Abdullah Alkanhal, Complexe de recherche interprofessionnel en aérothermochimie (CORIA), Centre National de la Recherche Scientifique (CNRS)-Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Laboratoire d'Etudes des Systèmes Thermiques et Energétiques [Monastir] (LESTE / ENIM), École Nationale d’Ingénieurs de Monastir (ENIM), and Azad University

Subjects
Convection, Materials science, lcsh:Hydraulic engineering, 020209 energy, Bubble, Geography, Planning and Development, 02 engineering and technology, Heat transfer coefficient, Aquatic Science, 01 natural sciences, Biochemistry, 010305 fluids & plasmas, [SPI.MECA.MEFL]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Fluids mechanics [physics.class-ph], Physics::Fluid Dynamics, lcsh:Water supply for domestic and industrial purposes, lcsh:TC1-978, Boiling, 0103 physical sciences, 0202 electrical engineering, electronic engineering, information engineering, contact angle, ComputingMilieux_MISCELLANEOUS, Water Science and Technology, convective flow, lcsh:TD201-500, annulus pipe, Mechanics, radial heat flux, total dissolved solid material, 6. Clean water, Heat flux, Heat transfer, Liquid bubble, Nucleate boiling, bubble formation
Abstract

Formation of bubbles in water inside an annulus pipe in a flow boiling regime was experimentally investigated. The effect of various variables, such as total dissolved solid materials (TDS) in terms of mass fraction, flow rate of water, and applied heat flux (HF) on the heat transfer coefficient (HTC) and bubble behavior of water, was experimentally investigated. A regression formula was fitted to estimate the average bubble diameter at various TDS values, with accuracy of &lt, 4.1% up to heat flux of 90 kW/m2. Results show that the presence of TDS materials can increase the contact angle of bubble and bubble diameter, and also promotes the HTC value of the system. However, flow rate of water suppressed bubble generation, and increased the heat transfer coefficient due to the renewal of the thermal boundary layer around the boiling surface. Likewise, it was identified that forced convective and nucleate boiling heat transfer mechanisms contribute to the flow of boiling water, and heat flux is a key parameter in determining the mechanism of heat transfer. In the present study, heat flux of 15 kW/m2 at 50 &deg, C was the heat flux in which onset of nucleate boiling was identified inside the annulus pipe. The contact angle of water at TDS values of 300 mg/L and 1200 mg/L was 74&deg, and 124&deg, respectively, showing the improvement in heat transfer characteristics of water due to the presence of TDS materials.

Published
2019

5. Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)

Author

Alessandro Larcher, Tommaso Silvestri, Cosimo De Nunzio, Andrea Tubaro, Alberto Breda, Alessandro Antonelli, Bo Yang, Joao Nuno Torres, Oscar Rodriguez Faba, Nicola Pavan, Riccardo Autorino, Kazunari Tanabe, L. Bevilacqua, Koon Ho Rha, Andrew Tracey, Francesco Porpiglia, Estefania Linares, Ahmet Bindayi, Francesco Montorsi, Jean Alexandre Long, Luigi Schips, Sisto Perdonà, Pierluigi Bove, Ottavio De Cobelli, Alexandre Mottrie, Claudio Simeone, Lance J. Hampton, Umberto Capitanio, Carmen Mir, Carlo Trombetta, Cristian Fiori, Ithaar Derweesh, Estevão Lima, Joan Palou, Antonio Celia, Salvatore Micali, Tobias Maurer, Matteo Ferro, Carlotta Palumbo, Giuseppe Quarto, Toshio Takagi, Gaelle Fiard, Chao Zhang, Roberto Castellucci, Alessandro Veccia, China Agricultural University (CAU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Department of Urology, Sant'Andrea Hospital - Sapienza University of Rome, Medical University Graz, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), OLVG Hospital, servicio de urologia, Fundación Puigvert, Institute of Information Engineering [Beijing] (IIE), Chinese Academy of Sciences [Beijing] (CAS), Department of Clinical and Molecular Medicine, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Department of urology, Università Vita-Salute San Raffaele, Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section, Università degli studi di Napoli Federico II, chair and department of urology, Antonelli, A., Veccia, A., Pavan, N., Mir, C., Breda, A., Takagi, T., Rha, K. H., Maurer, T., Zhang, C., Long, J. -A., De Nunzio, C., Lima, E., Ferro, M., Micali, S., Quarto, G., Linares, E., Celia, A., Schips, L., Bove, P., Larcher, A., Fiori, C., Mottrie, A., Bindayi, A., Trombetta, C., Silvestri, T., Palou, J., Faba, O. R., Tanabe, K., Yang, B., Fiard, G., Tubaro, A., Torres, J. N., De Cobelli, O., Bevilacqua, L., Castellucci, R., Tracey, A., Hampton, L. J., Montorsi, F., Perdona, S., Simeone, C., Palumbo, C., Capitanio, U., Derweesh, I., Porpiglia, F., and Autorino, R.

Subjects
Male, Laparoscopic surgery, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Aged, 80 and over, Asia, Carcinoma, Renal Cell, Europe, Female, Follow-Up Studies, Humans, Incidence, Kidney Neoplasms, Neoplasm Staging, Nephrectomy, Postoperative Complications, Retrospective Studies, Survival Rate, United States, resurge, 0302 clinical medicine, Retrospective Studie, Renal cell carcinoma, 80 and over, renal-cell carcinoma, kidney tumor, Kidney Neoplasm, 3. Good health, 030220 oncology & carcinogenesis, Human, Cohort study, medicine.medical_specialty, renal cell carcinoma, partial nephrectomy, Urology, elderly, Follow-Up Studie, 03 medical and health sciences, medicine, Survival rate, Aged, Cancer staging, business.industry, Carcinoma, Renal Cell, Postoperative complication, Retrospective cohort study, medicine.disease, Surgery, Settore MED/24, Postoperative Complication, business, elderly, renal cell carcinoma
Abstract

OBJECTIVE To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients >= 80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity. (C) 2019 Elsevier Inc.

Published
2019

6. Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)

Author

Kazunari Tanabe, Toshio Takagi, Ryan W. Dobbs, Maria Furlan, Gaelle Fiard, Matteo Ferro, Antonio Celia, Simone Crivellaro, Alberto Breda, Andrea Tubaro, Pierluigi Bove, Salvatore Micali, J. Torres, Paolo Umari, Ottavio De Cobelli, Alexandre Mottrie, Ali Abdel Raheem, Giulia Barbati, Umberto Capitanio, Francesco Porpiglia, Estefania Linares, Caterina Gregorio, Riccardo Autorino, Estevão Lima, Alessandro Antonelli, Bo Yang, Maria Carmen Mir, Tommaso Silvestri, Sisto Perdonà, Alfredo Aguilera, Thomas Amiel, Giuseppe Quarto, Jean Alexandre Long, Francesco Montorsi, Bernardino De Concilio, Zachary Hamilton, L. Bevilacqua, Ahmet Bindayi, Koon Ho Rha, Chao Zang, Carlotta Palumbo, Luigi Schips, Ithaar Derweesh, Nicola Pavan, Cosimo De Nunzio, Carlo Trombetta, Andrew Tracey, Joan Palou, Oscar Rodriguez-Faba, Roberto Castellucci, Christian Fiori, Alessandro Larcher, Tobias Maurer, Mir, Maria C, Pavan, Nicola, Capitanio, Umberto, Antonelli, Alessandro, Derweesh, Ithaar, Rodriguez-Faba, Oscar, Linares, Estefania, Takagi, Toshio, Rha, Koon H, Fiori, Christian, Maurer, Tobia, Zang, Chao, Mottrie, Alexandre, Umari, Paolo, Long, Jean-Alexandre, Fiard, Gaelle, De Nunzio, Cosimo, Tubaro, Andrea, Tracey, Andrew T, Ferro, Matteo, De Cobelli, Ottavio, Micali, Salvatore, Bevilacqua, Luigi, Torres, João, Schips, Luigi, Castellucci, Roberto, Dobbs, Ryan, Quarto, Giuseppe, Bove, Pierluigi, Celia, Antonio, De Concilio, Bernardino, Trombetta, Carlo, Silvestri, Tommaso, Larcher, Alessandro, Montorsi, Francesco, Palumbo, Carlotta, Furlan, Maria, Bindayi, Ahmet, Hamilton, Zachary, Breda, Alberto, Palou, Joan, Aguilera, Alfredo, Tanabe, Kazunari, Raheem, Ali, Amiel, Thoma, Yang, Bo, Lima, Estevão, Crivellaro, Simone, Perdona, Sisto, Gregorio, Caterina, Barbati, Giulia, Porpiglia, Francesco, Autorino, Riccardo, Mir, M. C., Pavan, N., Capitanio, U., Antonelli, A., Derweesh, I., Rodriguez-Faba, O., Linares, E., Takagi, T., Rha, K. H., Fiori, C., Maurer, T., Zang, C., Mottrie, A., Umari, P., Long, J. -A., Fiard, G., De Nunzio, C., Tubaro, A., Tracey, A. T., Ferro, M., De Cobelli, O., Micali, S., Bevilacqua, L., Torres, J., Schips, L., Castellucci, R., Dobbs, R., Quarto, G., Bove, P., Celia, A., De Concilio, B., Trombetta, C., Silvestri, T., Larcher, A., Montorsi, F., Palumbo, C., Furlan, M., Bindayi, A., Hamilton, Z., Breda, A., Palou, J., Aguilera, A., Tanabe, K., Raheem, A., Amiel, T., Yang, B., Lima, E., Crivellaro, S., Perdona, S., Gregorio, C., Barbati, G., Porpiglia, F., Autorino, R., Department of urology, Università Vita-Salute San Raffaele, OLVG Hospital, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Department of Urology, Sant'Andrea Hospital - Sapienza University of Rome, Department of Clinical and Molecular Medicine, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Medical University Graz, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), servicio de urologia, Fundación Puigvert, La Paz University Hospital, Institute of Information Engineering [Beijing] (IIE), Chinese Academy of Sciences [Beijing] (CAS), Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section, and Università degli studi di Napoli Federico II

Subjects
Nephrology, Male, medicine.medical_specialty, Asia, Urology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Renal function, Nephrectomy, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Elderly, Interquartile range, Internal medicine, medicine, Humans, Partial nephrectomy, Propensity Score, Carcinoma, Renal Cell, elderly, kidney cancer, nephrectomy, partial nephrectomy, Aged, Neoplasm Staging, Retrospective Studies, business.industry, Incidence, Age Factors, Retrospective cohort study, Kidney cancer, Middle Aged, medicine.disease, Kidney Neoplasms, Europe, Survival Rate, Settore MED/24, Treatment Outcome, 030220 oncology & carcinogenesis, Propensity score matching, Cohort, North America, Female, business, Glomerular Filtration Rate
Abstract

International audience; PURPOSE:To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor.PATIENTS AND METHODS:A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM).RESULTS:A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13-63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p

Published
2019

7. Patterns of use and patient characteristics: brachytherapy for localized prostate cancer in octo- and nonagenarians

Author

Fred Saad, Roger Valdivieso, Zhe Tian, Maxine Sun, Philip Wong, Marie-Élise Parent, Alessandro Larcher, Markus Graefen, Francesco Montorsi, Malek Meskawi, Pierre I. Karakiewicz, Katharina Boehm, Valdivieso, Roger, Boehm, Katharina, Meskawi, Malek, Larcher, Alessandro, Tian, Zhe, Parent Marie, Elise, Wong, Philip, Graefen, Marku, Montorsi, Francesco, Sun, Maxine, Saad, Fred, Karakiewicz Pierre, I., Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Department of Urology Université de Montréal, Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, IRCCS Ospedale San Raffaele, Centre Hospitalier de l'Université de Montréal (CHUM), Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), and This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Subjects
Male, Oncology, Nephrology, medicine.medical_specialty, Survival, genetic structures, [SDV]Life Sciences [q-bio], Urology, medicine.medical_treatment, Brachytherapy, Patient characteristics, Prostate cancer, Internal medicine, otorhinolaryngologic diseases, medicine, Humans, Retrospective Studies, Aged, 80 and over, Octo- and nonag, business.industry, Patient Selection, Localized prost, Elderly patient, Age Factors, Prostatic Neoplasms, social sciences, medicine.disease, Combined Modality Therapy, United States, humanities, Survival Rate, Treatment Outcome, Socioeconomic Factors, Treatment modality, business, psychological phenomena and processes, SEER Program
Abstract

International audience; Brachytherapy (BT) is a widely used treatment modality for elderly patients with localized prostate cancer (PCa). To describe the patterns of BT use in octo- and nonagenarians treated for localized PCa in the USA. We hypothesized that most individuals treated with BT should remain alive for at least 10 years. We also postulated that BT should ideally be administered as monotherapy. Using the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, 2701 octo- and nonagenarians treated with BT between 1992 and 2009 were identified. Cumulative incidence rates and smoothed cumulative incidence plots were used. In patients with low-risk characteristics, 40 % received BT alone; 27 % received BT combined with ADT; 19 % received BT and EBRT; and 14 % received BT combined with both ADT and EBRT. Of intermediate-to-high-risk patients, 19 % received BT alone; 16 % received BT combined with ADT; 19 % received BT combined with EBRT; and 45 % received BT together with ADT and EBRT. Overall survival rate was 79 and 47 % at 5 and 10 years. Less than half of elderly treated with BT remain alive at 10 years of follow-up. Moreover, the vast majority of those individuals not only receives BT, but is also exposed to two or even three combined therapy modalities. These findings are worrisome.

Published
2015

8. Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy

Author

Karim Bensalah, Nathalie Rioux-Leclercq, Evanguelos Xylinas, Shahrokh F. Shariat, Michael Rink, Christopher G. Wood, Aurélie Mbeutcha, Romain Mathieu, Ilaria Lucca, Vitaly Margulis, Christian Seitz, Alberto Briganti, Harun Fajkovic, Mihai Dorin Vartolomei, Morgan Rouprêt, Jay D. Raman, Andrea Haitel, Pierre I. Karakiewicz, Jose A. Karam, Alon Z. Weizer, Dept of Urology [Vienne], Medizinische Universität Wien = Medical University of Vienna, Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Dpt of Urology [Dallas], University of Texas Southwestern Medical Center [Dallas], Dpt of Urology [Houston], The University of Texas M.D. Anderson Cancer Center [Houston], Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Dept of Urology [Lausanne ], Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Dpt of Urology [Michigan], University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System, Division of Urology - Penn State Milton S., S. Hershey Medical Center, Service de Pathologie [Rennes] = Pathology [Rennes], CHU Pontchaillou [Rennes], Dpt of Pathology [Vienna], Medical University of Vienna, Department of Pathology, Dpt of Urology [Hamburg], Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Dpt of Urology [Milan], Vita-Salute San Raffaele University and Center for Translational Genomics and Bioinformatics, Service d'urologie, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Dpt of Urology [New York], Weill Medical College of Cornell University [New York], Department of Urology, Comprehensive Cancer Center, General Hospital of Vienna, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Vartolomei, Mihai Dorin, Mathieu, Romain, Margulis, Vitaly, Karam, Jose A., Rouprêt, Morgan, Lucca, Ilaria, Mbeutcha, Aurélie, Seitz, Christian, Karakiewicz, Pierre I., Fajkovic, Harun, Wood, Christopher G., Weizer, Alon Z., Raman, Jay D., Rioux-Leclercq, Nathalie, Haitel, Andrea, Bensalah, Karim, Rink, Michael, Briganti, Alberto, Xylinas, Evanguelo, Shariat, Shahrokh F., Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie et transplantation rénales [CHU Pitié-Salpêtrière], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Service de Pathologie [CHU Rennes]

Subjects
Male, Recurrence Death, Neutrophils, Lymphovascular invasion, medicine.medical_treatment, 030232 urology & nephrology, Kaplan-Meier Estimate, Nephrectomy, Gastroenterology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Leukocyte Count, 0302 clinical medicine, Retrospective Studie, Recurrence, Medicine, Lymphocytes, Multivariate Analysi, Neutrophil-to-lymphocyte ratio, Prognostic factor, Neutrophil, Kidney Neoplasm, Ureteral Neoplasm, Middle Aged, Prognosis, Kidney Neoplasms, Tumor Burden, 3. Good health, Death, 030220 oncology & carcinogenesis, Lymphocyte, Female, Original Article, Human, medicine.medical_specialty, Prognosi, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease-Free Survival, 03 medical and health sciences, Internal medicine, Carcinoma, Humans, Lymphocyte Count, Neutrophil to lymphocyte ratio, Ureteral neoplasm, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Carcinoma, Transitional Cell, Ureteral Neoplasms, business.industry, Proportional hazards model, fungi, Cancer, Retrospective cohort study, medicine.disease, Surgery, Multivariate Analysis, Proportional Hazards Model, Lymphadenectomy, Ureter, Urothelium, business
Abstract

International audience; Objective: Several retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-institutional cohort.Methods : Preoperative NLR was assessed in a multi-institutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess the association between NLR and lymph node metastasis, muscle-invasive and non-organ-confined disease. The association of altered NLR with recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Cox proportional hazards regression models.Results: Altered NLR was observed in 1428 (62.8 %) patients and associated with more advanced pathological tumor stage, lymph node metastasis, lymphovascular invasion, tumor necrosis and sessile tumor architecture. In a preoperative model that included age, gender, tumor location and architecture, NLR was an independent predictive factor for the presence of lymph node metastasis, muscle-invasive and non-organ-confined disease (p < 0.001). Within a median follow-up of 40 months (IQR 20–76 months), 548 (24.1 %) patients experienced disease recurrence and 453 patients (19.9 %) died from their cancer. Compared to patients with normal NLR, those with altered NLR had worse RFS (0.003) and CSS (p = 0.002). In multivariable analyses that adjusted for the effects of standard clinicopathologic features, altered NLR did not retain an independent value. In the subgroup of patients treated with lymphadenectomy in addition to RNU, NLR was independently associated with CSS (p = 0.03).Conclusion:In UTUC, preoperative NLR is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status. NLR may help better risk stratify patients with regard to lymphadenectomy and conservative therapy.

Published
2017

9. Role of Survivin expression in predicting biochemical recurrence after radical prostatectomy: a multi-institutional study

Author

Martin Susani, Yair Lotan, Pierre I. Karakiewicz, Aurélie Mbeutcha, Maxine Sun, Romain Mathieu, Francesco Montorsi, Alberto Briganti, Ilaria Lucca, Morgan Rouprêt, Tobias Klatte, Harun Fajkovic, Christian Seitz, Loidl Wolgang, Lukas Kenner, Vitaly Margulis, Mihai Dorin Vartolomei, Malte Rieken, Shahrokh F. Shariat, Michael Rink, Mathieu, R, Lucca, I, Vartolomei, Md, Mbeutcha, A, Klatte, T, Seitz, C, Karakiewicz, P, Fajkovic, H, Sun, M, Lotan, Y, Montorsi, Francesco, Briganti, A, Rouprêt, M, Margulis, V, Rink, M, Rieken, M, Kenner, L, Susani, M, Wolgang, L, Shariat, Sf, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Medizinische Universität Wien = Medical University of Vienna, Department of Urology, Hospital Barmherzige Brüder, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), University of Texas Southwestern Medical Center [Dallas]- The University of Texas Health Science Center at Houston (UTHealth), Department of urology, Università Vita-Salute San Raffaele, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Weill Medical College of Cornell University [New York], Department of Experimental Pharmacology and Toxicology, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE)-Cardiovascular Research Center, University Hospital Basel [Basel], BBVA Foundation - Cancer Cell Biology Programme, and Romain Mathieu is supported by the Scholarship Foundation of the Republic of Austria (OeAD) and by the – a European Association of Urology Scholarship (EUSP).

Subjects
0301 basic medicine, Oncology, Biochemical recurrence, Male, medicine.medical_specialty, recurrence, Prognosi, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Survivin, Urology, survivin, Inhibitor of Apoptosis Proteins, prostatic neoplasm, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Internal medicine, Inhibitor of Apoptosis Protein, Medicine, Humans, Lymph node, Retrospective Studies, Aged, Prostatectomy, Tissue microarray, business.industry, breakpoint cluster region, Prostatic Neoplasms, Middle Aged, Prostate-Specific Antigen, Prognosis, radical prostatectomy, Prostate-specific antigen, 030104 developmental biology, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Immunohistochemistry, Neoplasm Recurrence, Local, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Human
Abstract

Objective: To assess the association of survivin expression with clinicopathological features and biochemical recurrence (BCR) after radical prostatectomy (RP) in a large multi-institutional cohort. Methods: Survivin expression was evaluated by immunohistochemistry on a tissue microarray of RP cores from 3 117 patients. Survivin expression was considered altered when at least 10% of the tumour cells stained positive. The association of altered survivin expression with BCR was evaluated using Cox proportional hazards regression models. Results: Survivin expression was altered in 1 330 patients (42.6%). Altered expression was associated with higher Gleason score on RP (P = 0.001), extracapsular extension (P = 0.019), seminal vesicle invasion (P < 0.001) and lymph node metastases (P = 0.009). The median (interquartile range) follow-up was 38 (21–66) months. Patients with altered survivin expression had a shorter BCR-free survival time than those with normal expression (5-year BCR-free survival estimates: 74.7 vs 79.0%; P = 0.008). Altered survivin expression did not retain its prognostic value, however, after adjustment for the effect of established clinicopathological factors (P = 0.73). Subgroup analyses also showed no independent prognostic value of survivin. Conclusions: Survivin expression is commonly altered in patients undergoing RP. Altered survivin expression is associated with the clinicopathological features of biologically and clinically aggressive PCa. Survivin expression was associated with BCR only in univariable analysis, limiting its value in daily clinical decision-making.

Published
2017

10. Prognostic role of decreased E-cadherin expression in patients with upper tract urothelial carcinoma: a multi-institutional study

Author

Andrea Haitel, Solene Jacquet-Kammerer, Stênio de Cássio Zequi, Mesut Remzi, Christopher G. Wood, Alexander Bachmann, Alon Z. Weizer, Shahrokh F. Shariat, Isabela Werneck da Cunha, Nathalie Rioux-Leclercq, Morgan Rouprêt, Jose A. Karam, Bernhard Grubmüller, Karim Bensalah, Michael Rink, Christian Seitz, Atessa Bahadori, Ricardo L. Favaretto, Romain Mathieu, Yair Lotan, Vitaly Margulis, Alberto Briganti, Jay D. Raman, Pierre I. Karakiewicz, Department of Urology [Sao Paulo], A. C. Camargo Hospital [São Paulo], Dpt of Urology and Comprehensive Cancer Center [Vienne], Medizinische Universität Wien = Medical University of Vienna, Service de Neurologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Dpt of Pathology [Vienna], Medical University of Vienna, Department of Pathology, Dpt of Urology [Dallas], University of Texas Southwestern Medical Center [Dallas], Dpt of Urology [Houston], The University of Texas M.D. Anderson Cancer Center [Houston], Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Service d'urologie et transplantation rénales [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Dpt of Urology [Michigan], University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System, Division of Urology - Penn State Milton S., S. Hershey Medical Center, Service de Pathologie [CHU Rennes], CHU Pontchaillou [Rennes], Dpt of Urology [Basel], University Hospital Basel [Basel], Dpt of Urology [Hamburg], Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Dpt of Urology [Milan], Vita-Salute San Raffaele University and Center for Translational Genomics and Bioinformatics, Department of Urology, Weill Medical College of Cornell University [New York], Service de Neurologie [Rennes] = Neurology [Rennes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Pathologie [Rennes] = Pathology [Rennes], Favaretto, Ricardo L., Bahadori, Atessa, Mathieu, Romain, Haitel, Andrea, Grubmüller, Bernhard, Margulis, Vitaly, Karam, Jose A., Rouprêt, Morgan, Seitz, Christian, Karakiewicz, Pierre I., Cunha, Isabela W., Zequi, Stenio C., Wood, Christopher G., Weizer, Alon Z., Raman, Jay D., Remzi, Mesut, Rioux-Leclercq, Nathalie, Jacquet-Kammerer, Solene, Bensalah, Karim, Lotan, Yair, Bachmann, Alexander, Rink, Michael, Briganti, Alberto, Shariat, Shahrokh F., Service d'Urologie [CHU Pitié-Salpêtrière], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Nephrology, Male, Survival, Lymphovascular invasion, 030232 urology & nephrology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Neoplasms, Multiple Primary, 0302 clinical medicine, Interquartile range, Retrospective Studie, Recurrence, Stage (cooking), Multivariate Analysi, medicine.diagnostic_test, Kidney Neoplasm, Lymph Node, Middle Aged, Ureteral Neoplasm, Cadherins, Prognosis, Immunohistochemistry, Kidney Neoplasms, 3. Good health, 030220 oncology & carcinogenesis, Original Article, Female, Carcinoma in Situ, Human, medicine.medical_specialty, Prognosi, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease-Free Survival, 03 medical and health sciences, Antigens, CD, Internal medicine, Biopsy, medicine, Carcinoma, Humans, Retrospective Studies, Aged, Neoplasm Staging, Carcinoma, Transitional Cell, Ureteral Neoplasms, business.industry, Carcinoma in situ, E-cadherin, medicine.disease, Concomitant, Multivariate Analysis, Cadherin, Lymph Nodes, Neoplasm Grading, Urothelium, business, Prediction
Abstract

Purpose: To assess the role of E-cadherin as prognostic biomarker in upper tract urothelial carcinoma (UTUC) in a large multi-institutional cohort of patients. Methods: Immunohistochemistry technique was used to evaluate E-cadherin expression in 678 patients with unilateral, sporadic UTUC treated with RNU. E-cadherin expression was considered decreased if 10Â % or more cells had decreased expression (

Published
2017

11. Prostatitis, other genitourinary infections and prostate cancer: results from a population-based case-control study

Author

Marie-Élise Parent, Alessandro Larcher, Roger Valdivieso, Malek Meskawi, Pierre I. Karakiewicz, Markus Graefen, Jonas Schiffmann, Fred Saad, Maxine Sun, Katharina Boehm, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Department of Urology (Université de Montréal, University of Montreal Health Center), IRCCS Ospedale San Raffaele, Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), Department of Social and Preventive Medicine, and University of Montreal

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Case–control study, Urology, [SDV]Life Sciences [q-bio], Population, Prostatitis, Orchitis, urologic and male genital diseases, Risk Assessment, 03 medical and health sciences, Prostate cancer, Age Distribution, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Internal medicine, Diagnosis, Genitourinary infections, Humans, Medicine, Urethritis, Medical history, education, Aged, Retrospective Studies, Epididymitis, education.field_of_study, business.industry, Genitourinary system, Incidence, Quebec, Prostatic Neoplasms, Middle Aged, medicine.disease, 030104 developmental biology, Population Surveillance, 030220 oncology & carcinogenesis, business, Follow-Up Studies
Abstract

International audience; We relied on a population-based case-control study (PROtEuS) to examine a potential association between the presence of histologically confirmed prostate cancer (PCa) and history of genitourinary infections, e.g., prostatitis, urethritis, orchitis and epididymitis. Cases were 1933 men with incident PCa, diagnosed across Montreal hospitals between 2005 and 2009. Population controls were 1994 men from the same residential area and age distribution. In-person interviews collected information about socio-demographic characteristics, lifestyle and medical history, e.g., self-reported history of several genitourinary infections, as well as on PCa screening. Logistic regression analyses tested overall and grade-specific associations, including subgroup analyses with frequent PSA testing. After multivariable adjustment, prostatitis was associated with an increased risk of any PCa (OR 1.81 [1.44-2.27]), but not urethritis (OR 1.05 [0.84-1.30]), orchitis (OR 1.28 [0.92-1.78]) or epididymitis (OR 0.98 [0.57-1.68]). The association between prostatitis and PCa was more pronounced for low-grade PCa (Gleason ≤ 6: OR 2.11 [1.61-2.77]; Gleason ≥ 7: OR 1.59 [1.22-2.07]). Adjusting for frequency of physician visits, PSA testing frequency or restricting analyses to frequently screened subjects did not affect these results. Prostatitis was associated with an increased probability for detecting PCa even after adjustment for frequency of PSA testing and physician visits, but not urethritis, orchitis or epididymitis. These considerations may be helpful in clinical risk stratification of individuals in whom the risk of PCa is pertinent.

Published
2016

12. Prognostic Value of Extranodal Extension and Other Lymph Node Parameters in Patients With Upper Tract Urothelial Carcinoma

Author

Jay D. Raman, Thomas F. Chromecki, Eugene K. Cha, Christian Seitz, Gerhard Donner, Harun Fajkovic, Claudio Jeldres, Karim Bensalah, Vitaly Margulis, Armin Pycha, Mesut Remzi, Giacomo Novara, Alon Z. Weizer, Yair Lotan, Wassim Kassouf, Vincenzo Ficarra, Kazumasa Matsumoto, Eiji Kikuchi, Francesco Montorsi, Marco Roscigno, Pierre I. Karakiewicz, Douglas S. Scherr, Eckart Breinl, Shahrokh F. Shariat, Weill Medical College of Cornell University [New York], Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Department of Urology, University of Texas Southwestern Medical Center [Dallas]- The University of Texas Health Science Center at Houston (UTHealth), Departement of Oncological and Surgical Sciences, Universita degli Studi di Padova, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], University of Michigan [Ann Arbor], University of Michigan System, Keio University School of Medicine [Tokyo, Japan], Hospital Weinviertel-Korneuburg-Landesklinikum Korneuburg, General Hospital of Bolzano, Health Robotics S.r.l., Department of urology, Università Vita-Salute San Raffaele, Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Fajkovic, Harun, Cha Eugene, K., Jeldres, Claudio, Donner, Gerhard, Chromecki Thomas, F., Margulis, Vitaly, Novara, Giacomo, Lotan, Yair, Raman Jay, D., Kassouf, Wassim, Seitz, Christian, Bensalah, Karim, Weizer, Alon, Kikuchi, Eiji, Roscigno, Marco, Remzi, Mesut, Matsumoto, Kazumasa, Breinl, Eckart, Pycha, Armin, Ficarra, Vincenzo, Montorsi, Francesco, Karakiewicz Pierre, I., Scherr Douglas, S., and Shariat Shahrokh, F.

Subjects
Male, Oncology, MESH: Chi-Square Distribution, urothelial carcinoma carcinoma, MESH: Lymphatic Metastasis, medicine.medical_treatment, 030232 urology & nephrology, carcinoma, Nephrectomy, lymph node excision, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Proportional Hazards Models, neoplasm metastasis, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, MESH: Ureteral Neoplasms, Stage (cooking), Lymph node, Neoadjuvant therapy, MESH: Treatment Outcome, MESH: Statistics, Nonparametric, MESH: Follow-Up Studies, MESH: Neoplasm Staging, Prognosis, MESH: Urinary Bladder Neoplasms, 3. Good health, Treatment Outcome, medicine.anatomical_structure, Chemotherapy, Adjuvant, MESH: Chemotherapy, Adjuvant, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Lymph, Radiology, MESH: Neoplasm Recurrence, Local, medicine.medical_specialty, Urology, urinary tract, urothelium, Statistics, Nonparametric, MESH: Prognosis, 03 medical and health sciences, Internal medicine, medicine, Carcinoma, Humans, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Chi-Square Distribution, MESH: Humans, Ureteral Neoplasms, MESH: Lymph Node Excision, business.industry, Carcinoma in situ, MESH: Retrospective Studies, Retrospective cohort study, medicine.disease, MESH: Male, MESH: Nephrectomy, Urinary Bladder Neoplasms, Neoplasm Recurrence, Local, business, MESH: Female, Follow-Up Studies
Abstract

International audience; PURPOSE: We assessed the prognostic value of extranodal extension and other lymph node parameters in a large multicenter cohort of patients with lymph node metastasis after radical nephroureterectomy. MATERIALS AND METHODS: We retrospectively analyzed the records of 222 patients with lymph node metastasis treated with radical nephroureterectomy for upper tract urothelial carcinoma without neoadjuvant therapy. Each lymph node metastasis was microscopically evaluated for extranodal extension. RESULTS: A median of 4 lymph nodes (IQR 8) was removed. Two lymph nodes (IQR 2) were positive. Lymph node density was 51.3% (IQR 71.7%). Overall 110 patients (49.5%) had extranodal extension, which was associated with more advanced pT stage (p = 0.026). On multivariable analysis extranodal extension was associated with disease recurrence (p = 0.01) and cancer specific mortality (p = 0.013). When stratified by a 30% cutoff, lymph node density was associated with disease recurrence and cancer specific mortality on univariable but not multivariable analysis (p = 0.048 and 0.049, respectively). Adding extranodal extension to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p

Published
2012

13. The Prognostic Value of Erythrocyte Polyamine in the Post-Nephrectomy Stratification of Renal Cell Carcinoma Specific Mortality

Author

Giovanni Lughezzani, Françoise Bouet, Nathalie Rioux-Leclercq, Jean Jacques Patard, B. Cipolla, Pierre I. Karakiewicz, Jean Philippe Moulinoux, Véronique Catros-Quemener, Paul Perrotte, Pierre Bigot, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie, Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcomes Unit, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), Service d'anatomie et cytologie pathologiques [Rennes] = Anatomy and Cytopathology [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Privé Saint-Grégoire, Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), and De Villemeur, Hervé

Subjects
Male, Oncology, Pathology, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Spermidine, medicine.medical_treatment, Spermine, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, chemistry.chemical_compound, MESH: Aged, 80 and over, 0302 clinical medicine, Renal cell carcinoma, Prospective Studies, MESH: Spermine, MESH: Spermidine, Aged, 80 and over, MESH: Aged, 0303 health sciences, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, Middle Aged, Prognosis, Kidney Neoplasms, 3. Good health, Survival Rate, MESH: Young Adult, 030220 oncology & carcinogenesis, Female, Adult, medicine.medical_specialty, MESH: Survival Rate, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Prognosis, Young Adult, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Carcinoma, Humans, Carcinoma, Renal Cell, Aged, Retrospective Studies, 030304 developmental biology, MESH: Humans, business.industry, Cancer, MESH: Adult, MESH: Retrospective Studies, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Prospective Studies, MESH: Male, MESH: Nephrectomy, chemistry, MESH: Kidney Neoplasms, Polyamine, business, MESH: Female, Kidney cancer
Abstract

International audience; PURPOSE: The polyamines spermine and spermidine are ubiquitous polycationic structures which are essential for cell proliferation and differentiation. Circulating polyamines, spermine and spermidine, represent valuable prognostic markers in prostate cancer, acute leukemia and supratentorial malignant glioma. We tested whether spermine and spermidine could improve the prognostic ability of several established predictors of cancer specific mortality after partial or radical nephrectomy for renal cell carcinoma. MATERIALS AND METHODS: Testing was performed on 399 patients with stages T(1-4), N(0-2), M(0-1) renal cell carcinoma who were treated with radical or partial nephrectomy at a single institution between 1990 and 2007. Univariable and multivariable Cox regression models tested the prognostic ability of spermine and spermidine levels in cancer specific mortality predictions. Covariates consisted of TNM stage, Fuhrman grade, tumor size and symptom classification. Harrell's concordance index (c-index) quantified accuracy and 200 bootstrap resamples were used to correct for overfit bias. RESULTS: The 5-year cancer specific mortality-free survival of patients with spermine levels 3 or less, 3.1 to 8, 8.1 to 13 and greater than 13 nmol/8x10(9) erythrocytes was 88.8%, 75.8%, 40.2% and 21.8%, respectively. Similarly the 5-year cancer specific mortality-free survival of patients with spermidine levels 12 or less, 12.1 to 15, 15.1 to 21 and greater than 21 nmol/8x10(9) erythrocytes was 79.0%, 56.6%, 53.2% and 27.4%, respectively. On multivariable analyses addressing cancer specific mortality after surgery spermine (p = 0.007) and spermidine (p = 0.04) achieved independent predictor status. Consideration of spermine and spermidine also improved the accuracy of established cancer specific mortality predictors by 2.2% (p

Published
2010

14. Radical versus partial nephrectomy

Author

Paul Perrotte, Laurent Zini, Fred Saad, Jean Jacques Patard, Shahrokh F. Shariat, Umberto Capitanio, Elie Antebi, Francesco Montorsi, Claudio Jeldres, Pierre I. Karakiewicz, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cancer Prognostics and Health Outcomes Unit, Department of urology, Università Vita-Salute San Raffaele, Institut de Génétique et Développement de Rennes (IGDR), Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Funded by: University of Montreal Health Center Urology Associates/Fonds de la Recherche en Santé du Québec/ University of Montreal Department of Surgery/University of Montreal Health Center (CHUM) Foundation/ Association Française de Recherche sur le Cancer/Fondation de France-Fédération Nationale des Centres de Lutte Contre le Cancer/Association Française d'Urologie/Ministère Français des Affaires Etrangères et Européennes (Bourse Lavoisier), Zini, Laurent, Perrotte, Paul, Capitanio, Umberto, Jeldres, Claudio, Shariat Shahrokh, F., Antebi, Elie, Saad, Fred, Patard Jean, Jacque, Montorsi, Francesco, Karakiewicz Pierre, I., Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), and De Villemeur, Hervé

Subjects
Male, Cancer Research, medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, 030232 urology & nephrology, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, MESH: Postoperative Complications, medicine, Humans, Carcinoma, Renal Cell, Survival analysis, MESH: Humans, MESH: Middle Aged, business.industry, Proportional hazards model, Mortality rate, MESH: Carcinoma, Renal Cell, Middle Aged, medicine.disease, Survival Analysis, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Neoplasms, MESH: Male, 3. Good health, Surgery, MESH: Nephrectomy, Oncology, MESH: Survival Analysis, 030220 oncology & carcinogenesis, Cohort, MESH: SEER Program, Female, MESH: Kidney Neoplasms, business, MESH: Female, Kidney cancer, SEER Program, Kidney disease
Abstract

BACKGROUND: Relative to radical nephrectomy (RN), partial nephrectomy (PN) performed for renal cell carcinoma (RCC) may protect from non-cancer-related deaths. The authors tested this hypothesis in a cohort of PN and RN patients. METHODS: The Surveillance, Epidemiology, and End Results-9 database allowed identification of 2198 PN (22.4%) and 7611 RN (77.6%) patients treated for T1aN0M0 RCC between 1988 and 2004. Analyses matched for age, year of surgery, tumor size, and Fuhrman grade addressed the effect of nephrectomy type (RN vs PN) on overall mortality (Cox regression models) and on non-cancer-related mortality (competing-risks regression models). RESULTS: Relative to PN, RN was associated with 1.23-fold (P = .001) increased overall mortality rate, which translated into a 4.9% and 3.1% absolute increase in mortality at 5 and 10 years after surgery, respectively. Similarly, non-cancer-related death rate was significantly higher after RN in competing-risks regression models (P < .001), which translated into a 4.6% and 4.5% absolute increase in non-cancer-related mortality at 5 and 10 years after surgery, respectively. CONCLUSIONS: Relative to PN, RN predisposes to an increase in overall mortality and non-cancer-related death rate in patients with T1a RCC. In consequence, PN should be attempted whenever technically feasible. Selective referrals should be considered if PN expertise is unavailable Cancer 2009. © 2009 American Cancer Society.

Published
2009

15. Waist circumference, waist-hip ratio, body mass index, and prostate cancer risk: results from the North-American case-control study Prostate Cancer & Environment Study

Author

José Sosa, Jonas Schiffmann, Pierre I. Karakiewicz, Audrey Blanc-Lapierre, Markus Graefen, Marie-Élise Parent, Katharina Boehm, Alessandro Larcher, Fred Saad, Maxine Sun, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, IRCCS Ospedale San Raffaele, Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), and Department of Urology Université de Montréal

Subjects
Male, [SDV]Life Sciences [q-bio], Waist–hip ratio, Abdominal obesity, Body mass index, Waist-to-height ratio, MESH: Aged, education.field_of_study, Prostate cancer, MESH: Middle Aged, MESH: Waist-Hip Ratio, Case-control study, MESH: Follow-Up Studies, MESH: Neoplasm Staging, Middle Aged, Prognosis, MESH: Case-Control Studies, Oncology, Obesity, Abdominal, MESH: Waist Circumference, Waist circumference, medicine.symptom, medicine.medical_specialty, Waist, Urology, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Prognosis, MESH: Body Mass Index, MESH: Obesity, Abdominal, Internal medicine, medicine, MESH: United States, Humans, Obesity, education, Aged, Neoplasm Staging, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, MESH: Humans, Body volume index, business.industry, Abdominal fat, Prostatic Neoplasms, Odds ratio, United States, MESH: Male, Surgery, Case-Control Studies, Waist-hip ratio, MESH: Prostatic Neoplasms, business, Follow-Up Studies
Abstract

Introduction The evidence on the association between anthropometric measures quantifying body fatness and prostate cancer (PCa) risk is not entirely consistent. Associations among waist circumference (WC), waist-hip ratio, body mass index (BMI), and PCa risk were assessed in a population-based case-control study. Patients and methods The study included 1933 incident PCa cases diagnosed between 2005 and 2009. Population controls were 1994 age-matched (±5 y) Montreal residents selected from electoral lists. Information on sociodemographics, medical history including PCa screening, height, weight, and waist and hip circumferences was collected through interviews. Logistic regression was used to assess odds ratios (ORs) for the association between anthropometric measures, and overall and grade-specific PCa. Results After adjustment for BMI, an excess risk of high-grade PCa (Gleason≥7) was associated with a WC ≥102 cm (OR = 1.47 [1.22–1.78]) and with a waist-hip ratio >1.0 (OR = 1.20 [1.01–1.43]). Men with a BMI≥30 kg/m 2 had a lower risk of PCa, regardless of grade. Restricting to subjects recently screened for PCa did not alter findings. Conclusion Elevated BMI was associated with a lower risk of PCa, regardless of grade. Contrastingly, abdominal obesity, when adjusted for BMI, yielded results in the opposite direction. Taken together, our observations suggest that the specific body fat distribution (abdominal), for a given BMI, is a predictor of PCa risk, whereas BMI alone is not. BMI and abdominal obesity, especially when measured by the WC, should be examined conjointly in future studies on this issue and may require consideration at patient counseling.

Published
2015

16. Metabolic syndrome and prostate cancer risk in a population-based case-control study in Montreal, Canada

Author

Fred Saad, Audrey Blanc-Lapierre, Pierre I. Karakiewicz, Armen Aprikian, Andrea R. Spence, Marie-Élise Parent, Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Department of Urology Université de Montréal, McGill University Health Center [Montreal] (MUHC), and This study was supported financially through grants from the Canadian Cancer Society, the Cancer Research Society, the Fonds de Recherche du Québec - Santé (FRQS), FRQS-RRSE, and the Ministère du Développement économique, de l'Innovation et de l'Exportation du Québec. Marie-Élise Parent and Pierre I. Karakiewicz have held career awards from the FRQS. Fred Saad holds the University of Montreal Endowed Chair in Prostate Cancer Research.

Subjects
Gerontology, Male, MESH: Quebec, Epidemiology, [SDV]Life Sciences [q-bio], MESH: Logistic Models, MESH: Hypertension, Prostate cancer, 0302 clinical medicine, MESH: Metabolic Syndrome X, MESH: Risk Factors, Odds Ratio, Prevalence, 030212 general & internal medicine, Age of Onset, Abdominal obesity, MESH: Aged, education.field_of_study, MESH: Middle Aged, Quebec, Middle Aged, Metabolic syndrome, MESH: Case-Control Studies, 3. Good health, Case–control studies, Prostate cancer screening, 030220 oncology & carcinogenesis, Obesity, Abdominal, Hypertension, medicine.symptom, Research Article, MESH: Diabetes Mellitus, Type 2, Adult, medicine.medical_specialty, MESH: Age of Onset, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Obesity, Abdominal, 03 medical and health sciences, Internal medicine, medicine, Humans, education, Case – control studies, MESH: Prevalence, Aged, Dyslipidemias, MESH: Humans, business.industry, MESH: Dyslipidemias, Case-control study, Public Health, Environmental and Occupational Health, Cancer, Prostatic Neoplasms, MESH: Adult, Odds ratio, medicine.disease, MESH: Odds Ratio, MESH: Male, Logistic Models, Diabetes Mellitus, Type 2, Risk factors, Case-Control Studies, MESH: Prostatic Neoplasms, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Background The role of metabolic syndrome (MetS) in prostate cancer risk is still debated. We investigated it in a large population-based case–control study. Methods Cases were 1937 men with incident prostate cancer, aged ≤75 years, diagnosed across French hospitals in the Montreal area between 2005 and 2009. Concurrently, 1995 population controls from the same residential area and age distribution were randomly selected from electoral list of French-speaking men. Detailed lifestyle and medical histories, and anthropometric measures, were collected during in-person interviews. Prevalence of MetS components (type 2 diabetes, high blood pressure, dyslipidemia and abdominal obesity) was estimated at 2 years before diagnosis for cases/ interview for controls, and at ages 20, 40, 50 and 60. Logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals for the association between MetS and prostate cancer risk. Results A history of MetS (≥3 components vs

Published
2015

17. Multi-institutional validation of the prognostic value of Ki-67 labeling index in patients treated with radical prostatectomy

Author

Alberto Briganti, Karim Bensalah, Pierre I. Karakiewicz, Douglas S. Scherr, Morgan Rouprêt, Vitaly Margulis, Malte Rieken, Evanguelos Xylinas, Yair Lotan, Francesco Montorsi, Romain Mathieu, Christian Seitz, Maxine Sun, Luis A. Kluth, Markus Margreiter, Ilaria Lucca, Shahrokh F. Shariat, Harun Fajkovic, Alexander Bachman, Michael Rink, Brian D. Robinson, Ashutosh K. Tewari, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Medizinische Universität Wien = Medical University of Vienna, Weill Medical College of Cornell University [New York], Department of Urology, University of Texas Southwestern Medical Center [Dallas]- The University of Texas Health Science Center at Houston (UTHealth), Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Department of urology, Università Vita-Salute San Raffaele, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Department of Experimental Pharmacology and Toxicology, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE)-Cardiovascular Research Center, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Sorbonne Université] (IUC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Mathieu, Romain, Shariat Shahrokh, F., Seitz, Christian, Karakiewicz Pierre, I., Fajkovic, Harun, Sun, Maxine, Lotan, Yair, Scherr Douglas, S., Tewari, Ashutosh, Montorsi, Francesco, Briganti, Alberto, Roupret, Morgan, Lucca, Ilaria, Margulis, Vitaly, Rink, Michael, Kluth Luis, A., Rieken, Malte, Bachman, Alexander, Xylinas, Evanguelo, Robinson Brian, D., Bensalah, Karim, and Margreiter, Markus

Subjects
Oncology, Male, Neoplasm, Residual, Lymphovascular invasion, medicine.medical_treatment, 030232 urology & nephrology, Prostate cancer, 0302 clinical medicine, Retrospective Studie, biology, Prostatectomy, Kallikrein, Middle Aged, Prognosis, Radical prostatectomy, Immunohistochemistry, 3. Good health, Prostate-specific antigen, Local, 030220 oncology & carcinogenesis, Ki-67, Residual, Kallikreins, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Human, Biochemical recurrence, Adult, medicine.medical_specialty, Prognosi, Urology, 03 medical and health sciences, Internal medicine, medicine, Adjuvant therapy, Humans, prostate-specific antigen, Neoplasm Invasiveness, Aged, Neoplasm Staging, Retrospective Studies, Neoplasm Invasivene, prostatectomy, business.industry, Proportional hazards model, Prostatic Neoplasms, Prostate-Specific Antigen, medicine.disease, Disease recurrence, Ki-67 Antigen, Neoplasm Recurrence, Prostatic Neoplasm, biology.protein, Neoplasm, Neoplasm Recurrence, Local, business
Abstract

Objective: Several smaller single-center studies have reported a prognostic role for Ki-67 labeling index in prostate cancer. Our aim was to test whether Ki-67 is an independent prognostic marker of biochemical recurrence (BCR) in a large international cohort of patients treated with radical prostatectomy (RP). Methods: Ki-67 immunohistochemical staining on prostatectomy specimens from 3,123 patients who underwent RP for prostate cancer was retrospectively performed. Univariable and multivariable Cox regression models were used to assess the association of Ki-67 status with BCR. Results: Ki-67Âpositive status was observed in 762 (24.4Â%) patients and was associated with lymph node involvement (LNI) (pÂ=Â0.039). Six hundred and twenty-one (19.9Â%) patients experienced BCR. The estimated 3-year biochemical-free survivals were 85Â% for patients with negative Ki-67 status and 82.1Â% for patients with positive Ki-67 status (log-rank test, pÂ=Â0.014). In multivariable analysis that adjusted for the effects of age, preoperative PSA, RP Gleason sum, seminal vesicle invasion, extracapsular extension, positive surgical margins, lymphovascular invasion, and LNI, Ki-67 was significantly associated with BCR (HRÂ=Â1.19; pÂ=Â0.019). Subgroup analysis revealed that Ki-67 is associated with BCR in patients without LNI (pÂ=Â0.004), those with RP Gleason sum 7 (pÂ=Â0.015), and those with negative surgical margins (pÂ=Â0.047). Conclusion: We confirmed Ki-67 as an independent predictor of BCR after RP. Ki-67 could be particularly informative in patients with favorable pathologic characteristics to help in the clinical decision-making regarding adjuvant therapy and optimized follow-up scheduling.

Published
2015

18. BPH: a tell-tale sign of prostate cancer? Results from the Prostate Cancer and Environment Study (PROtEuS)

Author

Katharina Boehm, Maxine Sun, Fred Saad, Markus Graefen, Alessandro Larcher, Roger Valdivieso, Pierre I. Karakiewicz, Malek Meskawi, Marie-Élise Parent, Audrey Blanc-Lapierre, José Sosa, Deborah Weiss, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Department of Urology Université de Montréal, IRCCS Ospedale San Raffaele, Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), Department of Social and Preventive Medicine, University of Montreal, and This study was supported financially through grants from the Canadian Cancer Society, the Cancer Research Society, the Fonds de la recherche du Québec—Santé (FRQS), FRQS-RRSE, and the Ministère du Développement économique, de l’Innovation et de l’Exportation du Québec. Marie-Élise Parent holds career awards from the FRQS. Fred Saad holds the University of Montreal Endowed Chair in Prostate Cancer Research

Subjects
Nephrology, Oncology, PCA3, Male, medicine.medical_specialty, Canada, Prostate biopsy, Time Factors, Case–control study, Urology, [SDV]Life Sciences [q-bio], Population, Prostatic Hyperplasia, Logistic regression, urologic and male genital diseases, Prostate cancer, 5-alpha Reductase Inhibitors, Risk Factors, Internal medicine, Diagnosis, medicine, Humans, Medical history, education, Aged, education.field_of_study, medicine.diagnostic_test, business.industry, Case-control study, Prostatic Neoplasms, Middle Aged, Prostate-Specific Antigen, medicine.disease, Benign prostatic hypertrophy, Logistic Models, Socioeconomic Factors, Case-Control Studies, business
Abstract

International audience; In a population-based case-control study (PROtEuS), we examined the association between prostate cancer (PCa) and (1) benign prostatic hypertrophy (BPH) history at any time prior to PCa diagnosis, (2) BPH-history reported at least 1 year prior to interview/diagnosis (index date) and (3) exposure to BPH-medications. Cases were 1933 men with incident prostate cancer diagnosed across Montreal French hospitals between 2005 and 2009. Population controls were 1994 men from the same age distribution and residential area. In-person interviews collected socio-demographic characteristics and medical history, e.g., BPH diagnosis, duration and treatment, as well as on PCa screening. Logistic regression analyses tested overall and grade-specific associations, including subgroup analyses with frequent PSA testing. A BPH-history was associated with an increased risk of PCa (OR 1.37 [95 % CI 1.16-2.61]), more pronounced for low-grade PCa (Gleason ≤6: OR 1.54 [1.26-1.87]; Gleason ≥7: OR 1.05 [0.86-1.27]). The association was not significant when BPH-history diagnosis was more than 1 year prior to index date, except for low-grade PCa (OR 1.29 [1.05-1.60]). Exposure to 5α reductase inhibitors (5α-RI) resulted in a decreased risk of overall PCa (OR 0.62 [0.42-0.92]), particularly for intermediate- to high-grade PCa (Gleason ≤6: OR 0.70 [0.43-1.14]; Gleason ≥7: OR 0.43 [0.26-0.72]). Adjusting for PSA testing frequency or restricting analyses to frequently screened subjects did not affect these results. BPH-history was associated with an increased PCa risk, which disappeared, when BPH-history did not include BPH diagnosis within the previous year. Our results also suggest that 5α-RI exposure exerts a protective effect on intermediate and high-grade PCa.

Published
2014

19. Risk of cancer-specific mortality following recurrence after radical nephroureterectomy

Author

Jay D. Raman, Richard Zigeuner, Jens Hansen, Shahrokh F. Shariat, Wassim Kassouf, Mesut Remzi, Andrew J. Vickers, Armin Pycha, Yair Lotan, Juan Ignacio Martínez-Salamanca, Felix K.-H. Chun, Karim Bensalah, Eugene K. Cha, Christian Seitz, Evanguelos Xylinas, Evi Comploj, Pierre I. Karakiewicz, Douglas S. Scherr, Surena F. Matin, Daniel Sjöberg, Michael Rink, Eiji Kikuchi, Vitaly Margulis, Giacomo Novara, Richard K. Lee, Weill Medical College of Cornell University [New York], Department of Experimental Pharmacology and Toxicology, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE)-Cardiovascular Research Center, General Hospital of Bolzano, Health Robotics S.r.l., Department of Urology, University of Texas Southwestern Medical Center [Dallas]- The University of Texas Health Science Center at Houston (UTHealth), Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Hospital Weinviertel-Korneuburg-Landesklinikum Korneuburg, Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Keio University School of Medicine [Tokyo, Japan], Medical University Graz, This study was conducted for the Upper Tract Urothelial Carcinoma Collaboration (UTUCC)., Service d'urologie [Rennes] = Urology [Rennes], and Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
Male, 030232 urology & nephrology, Disease, Nephrectomy, Cohort Studies, 0302 clinical medicine, Risk Factors, Surgical oncology, MESH: Risk Factors, Medicine, MESH: Ureteral Neoplasms, Cancer specific mortality, MESH: Cohort Studies, Urothelial carcinoma, MESH: Aged, MESH: Middle Aged, MESH: Follow-Up Studies, MESH: Neoplasm Staging, Middle Aged, Prognosis, 3. Good health, Survival Rate, Natural history, Oncology, 030220 oncology & carcinogenesis, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, MESH: Neoplasm Recurrence, Local, Cohort study, medicine.medical_specialty, MESH: Survival Rate, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Article, MESH: Prognosis, 03 medical and health sciences, Humans, Survival rate, Aged, Neoplasm Staging, MESH: Humans, Ureteral Neoplasms, business.industry, MESH: Lymph Node Excision, MESH: Male, MESH: Nephrectomy, Upper tract, Lymph Node Excision, Surgery, Neoplasm Recurrence, Local, business, MESH: Female, Follow-Up Studies
Abstract

International audience; PURPOSE: To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). METHODS: Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence. RESULTS: The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). A total of 491 (82 %) of 597 patients died from UTUC, and 8 patients (1.3 %) died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 %. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p < 0.0005) and a shorter interval from surgery to disease recurrence (p < 0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively. CONCLUSIONS: Approximately 80 % of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.

Published
2012

20. Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival: proposal for a revision of the current TNM classification

Author

Kanishka Sircar, Shahrokh F. Shariat, Theresa M. Koppie, Wassim Kassouf, Shuji Mikami, Casey K. Ng, Michael Rink, Richard Zigeuner, Christopher G. Wood, Karim Bensalah, Felix K.-H. Chun, Wareef Kabbani, Charles C. Guo, Eiji Kikuchi, Vitaly Margulis, Mesut Remzi, Andrea Haitel, Jay D. Raman, Pierre I. Karakiewicz, Douglas S. Scherr, Jens Hansen, Cord Langner, Weill Medical College of Cornell University [New York], Department of Urology, Medical University Graz, Department of Experimental Pharmacology and Toxicology, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE)-Cardiovascular Research Center, University of Texas Southwestern Medical Center [Dallas]- The University of Texas Health Science Center at Houston (UTHealth), Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Keio University School of Medicine [Tokyo, Japan], McGill University = Université McGill [Montréal, Canada], Hospital Weinviertel-Korneuburg-Landesklinikum Korneuburg, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Medizinische Universität Wien = Medical University of Vienna, Cancer Prognostics and Health Outcome Unit, Service d'urologie [Rennes], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
Male, MESH: Carcinoma, 030232 urology & nephrology, Disease, urologic and male genital diseases, Nephrectomy, Cancer specific survival, 0302 clinical medicine, MESH: Aged, 80 and over, Urothelial carcinoma, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Hazard ratio, MESH: Neoplasm Staging, Middle Aged, Prognosis, Renal pelvicalyceal system, TNM classification, Kidney Neoplasms, 3. Good health, Treatment Outcome, 030220 oncology & carcinogenesis, Cohort, pT3 subclassification, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, MESH: Neoplasm Recurrence, Local, Adult, medicine.medical_specialty, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease-Free Survival, MESH: Prognosis, 03 medical and health sciences, medicine, Humans, Aged, Neoplasm Staging, Retrospective Studies, MESH: Humans, Genitourinary system, business.industry, Proportional hazards model, Carcinoma, Retrospective cohort study, MESH: Adult, MESH: Retrospective Studies, MESH: Urothelium, MESH: Male, Surgery, MESH: Nephrectomy, MESH: Disease-Free Survival, Upper urinary tract, Neoplasm Recurrence, Local, Urothelium, MESH: Kidney Neoplasms, business, MESH: Female
Abstract

Background The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable. Objectives The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients. Design, setting, and participants From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue). Intervention RNU. Measurements Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses. Results and limitations Of 858 patients with renal pelvicalyceal tumors, 266 (31%) had pT3 disease. Of these, 146 (54.9%) were classified as pT3a and 120 (45.1%) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58% vs pT3b 38%; p 0.001) and cancer-specific (pT3a 60% vs pT3b 39%; p = 0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p = 0.003) and cancer-specific mortality (HR: 1.7; p = 0.02). The major limitation is the retrospective character of the study. Conclusions Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer–International Union Against Cancer TNM classification system.

Published
2012

21. Impact of Histological Variants on Clinical Outcomes of Patients with Upper Urinary Tract Urothelial Carcinoma

Author

Jay D. Raman, Jens Hansen, Karim Bensalah, Eiji Kikuchi, Yair Lotan, Armin Pycha, Felix K.-H. Chun, Nathalie Rioux-Leclercq, Kanishka Sircar, Vitaly Margulis, Casey K. Ng, Wareef Kabbani, Andrea Haitel, Shahrokh F. Shariat, Michael Rink, Evi Comploj, Maxine Sun, Eugene K. Cha, Charles C. Guo, Brian D. Robinson, David A. Green, Mesut Remzi, Wassim Kassouf, Guru Sonpavde, Pierre I. Karakiewicz, Douglas S. Scherr, Department of Experimental Pharmacology and Toxicology, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE)-Cardiovascular Research Center, Weill Medical College of Cornell University [New York], Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), General Hospital of Bolzano, Health Robotics S.r.l., Department of Urology, University of Texas Southwestern Medical Center [Dallas]- The University of Texas Health Science Center at Houston (UTHealth), Department of Urologic Oncology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania Commonwealth System of Higher Education (PCSHE)-Penn State System-Pennsylvania Commonwealth System of Higher Education (PCSHE)-Penn State System, Hospital Weinviertel-Korneuburg-Landesklinikum Korneuburg, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], McGill University = Université McGill [Montréal, Canada], Medizinische Universität Wien = Medical University of Vienna, Department of Pathology, The University of Texas M.D. Anderson Cancer Center [Houston], Keio University School of Medicine [Tokyo, Japan], and De Villemeur, Hervé

Subjects
Male, Pathology, Lymphovascular invasion, medicine.medical_treatment, Statistics as Topic, 030232 urology & nephrology, Kaplan-Meier Estimate, carcinoma, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 0302 clinical medicine, Medicine, Upper urinary tract, Middle Aged, Combined Modality Therapy, Kidney Neoplasms, 3. Good health, Cell Transformation, Neoplastic, Chemotherapy, Adjuvant, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Disease Progression, Female, Adult, medicine.medical_specialty, kidney, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, histology, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Carcinoma, Humans, Neoplasm Invasiveness, Kidney surgery, Urothelium, Ureteral neoplasm, Aged, Neoplasm Staging, Carcinoma, Transitional Cell, Ureteral Neoplasms, business.industry, Histology, urothelium, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Survival Analysis, Multivariate Analysis, prognosis, Ureter, business, Follow-Up Studies
Abstract

International audience; PURPOSE: We investigated the clinical and prognostic impact of variant histologies on upper tract urothelial carcinoma outcomes after radical nephroureterectomy. MATERIALS AND METHODS: Data on 1,648 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy without preoperative chemotherapy or radiotherapy were reviewed for histological differentiation and variants. We analyzed differences between pure upper tract urothelial carcinoma and upper tract urothelial carcinoma with variant histology, and differences in the histological variants using different stratifications. RESULTS: A total of 398 patients (24.2%) had histological upper tract urothelial carcinoma variants. The most common variants were squamous cell and glandular differentiation in 9.9% and 4.4% of cases, respectively. Histological variants were associated with advanced tumor stage, tumor multifocality, sessile tumor architecture, tumor necrosis, lymphovascular invasion and lymph node metastasis compared to pure upper tract urothelial carcinoma (p ≤0.031). On univariable analysis variant histology was associated with disease recurrence (p = 0.002) and cancer specific mortality (p = 0.003). In 174 patients treated with adjuvant chemotherapy there was no difference in disease recurrence or survival between variant histology and pure upper tract urothelial carcinoma (p = 0.42 and 0.59, respectively). On multivariable analysis adjusted for the effects of standard clinicopathological characteristics variant histology was not associated with either end point. CONCLUSIONS: Almost 25% of patients with upper tract urothelial carcinoma treated with radical nephroureterectomy harbored histological variants. Variant histology was associated with features of biologically aggressive upper tract urothelial carcinoma. While variant histology is associated with worse outcomes on univariable analysis but this effect did not remain significant on multivariable analysis.

Published
2012

22. Tumor grade improves the prognostic ability of American Joint Committee on Cancer stage in patients with penile carcinoma

Author

Mathieu Latour, Daniel Liberman, Maxine Sun, Giovanni Lughezzani, Rodolphe Thuret, Monica Morgan, Paul Perrotte, Firas Abdollah, François Iborra, Pierre I. Karakiewicz, Lars Budäus, Shahrokh F. Shariat, Jean-Jacques Patard, Claudio Jeldres, J Guiter, Rupinder Johal, Service Urologie [Lapeyronie], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Department of urology, Università Vita-Salute San Raffaele, Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Department of Urology, Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], and De Villemeur, Hervé

Subjects
Oncology, Male, 030232 urology & nephrology, MESH: Lymph Nodes, Kaplan-Meier Estimate, MESH: Risk Assessment, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Proportional Hazards Models, 0302 clinical medicine, Penile Carcinoma, Surveillance, Epidemiology, and End Results, MESH: Incidence, Stage (cooking), Societies, Medical, MESH: Middle Aged, Incidence, Biopsy, Needle, MESH: Guidelines as Topic, MESH: Carcinoma, Squamous Cell, MESH: Neoplasm Staging, Middle Aged, Prognosis, Primary tumor, Immunohistochemistry, MESH: Predictive Value of Tests, 3. Good health, MESH: Young Adult, 030220 oncology & carcinogenesis, Predictive value of tests, MESH: Survival Analysis, Carcinoma, Squamous Cell, MESH: SEER Program, MESH: Neoplasm Recurrence, Local, MESH: Rare Diseases, Adult, medicine.medical_specialty, MESH: Biopsy, Needle, Urology, MESH: Societies, Medical, MESH: Nomograms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Guidelines as Topic, Risk Assessment, MESH: Multivariate Analysis, MESH: Prognosis, Disease-Free Survival, 03 medical and health sciences, Young Adult, MESH: Penile Neoplasms, Age Distribution, Rare Diseases, [SDV.CAN] Life Sciences [q-bio]/Cancer, Predictive Value of Tests, Internal medicine, MESH: Analysis of Variance, medicine, Carcinoma, Penile cancer, Humans, MESH: Age Distribution, Penile Neoplasms, MESH: Kaplan-Meier Estimate, Neoplasm Staging, Proportional Hazards Models, Analysis of Variance, MESH: Humans, business.industry, Cancer, MESH: Adult, MESH: Immunohistochemistry, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Survival Analysis, MESH: Male, Surgery, Nomograms, MESH: Disease-Free Survival, Multivariate Analysis, Lymph Nodes, Neoplasm Recurrence, Local, business, SEER Program
Abstract

International audience; PURPOSE: Penile cancer is rare. Thus, predicting cancer specific mortality may be difficult. We devised an accurate and yet easily applicable predictive rule that compares favorably with 2 previous models (73.8% and 74.7% accuracy, respectively). MATERIALS AND METHODS: We identified patients treated with primary tumor excision for all stages of penile squamous cell carcinoma between 1998 and 2006. Disease stage definitions using Surveillance, Epidemiology and End Results stage, American Joint Committee on Cancer stage and TNM classification, and tumor grade were used to predict cancer specific mortality. Predictive accuracy estimates were compared using the DeLong method for related AUCs. RESULTS: Surveillance, Epidemiology and End Results stage alone (1 predictor variable) was least accurate (74.5%). American Joint Committee on Cancer stage with tumor grade (2 predictor variables) was the most simple and most accurate (80.9%, p

Published
2010

23. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery

Author

Romain Spie, Jérôme Rigaud, Jacques Tostain, Michel Soulié, Bastien Rambeaud, Hendrik Van Poppel, Alfredo Aguilera, Maxime Crepel, Laurent Zini, Ofer Nativ, Jean Marie Ferriere, Luis Martinez Pineiro, Steven Joniau, Patrick J. Bastian, Rodolphe Thuret, Jean Jacques Patard, Stefan C. Müller, Frédéric Pouliot, Jean-Christophe Bernhard, Amnon Zisman, Andreas H. Wille, Christian Pfister, Pascal Rischmann, Nicolas Mottet, Laurent Bellec, Alexandre de la Taille, Allan J. Pantuck, Laurent Guy, Thierry Dujardin, R. Avakian, Jan Roigas, François Richard, Nathalie Rioux-Leclercq, Christian Doehn, Pierre I. Karakiewicz, Arie S. Belldegrun, Roberto Bertini, Orit E. Raz, Karim Bensalah, Laurent Salomon, B. Albouy, T. Culty, Thierry Lebret, Morgan Rouprêt, A. Villers, Francesco Montorsi, Fabien Saint, Herve Lang, Roy Farfara, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Department of Urology, University of California [Los Angeles] (UCLA), University of California-University of California, Service Urologie [Lapeyronie], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcome Unit, Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Université Jean Monnet [Saint-Étienne] (UJM), Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), National and Kapodistrian University of Athens (NKUA), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Université Fédérale Toulouse Midi-Pyrénées, Université de Nantes (UN), Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS)-Clermont Université, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Hôpital Foch [Suresnes], Université de Picardie Jules Verne (UPJV), Assaf Harofeh Medical Centre, Tel Aviv University [Tel Aviv]-Assaf Harofeh Medical Centre, CHU Strasbourg, Berlin Charity Hospital, La Paz University Hospital, Bnai Zion Hospital, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Lubeck University Hospital, Bonn University Hospital, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), University of California (UC)-University of California (UC), CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, Université Jean Monnet - Saint-Étienne (UJM), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), Tel Aviv University (TAU)-Assaf Harofeh Medical Centre, Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), De Villemeur, Hervé, Bensalah, Karim, Pantuck Allan, J., Rioux Leclercq, Nathalie, Thuret, Rodolphe, Montorsi, Francesco, Karakiewicz Pierre, I., Mottet, Nicola, Zini, Laurent, Bertini, Roberto, Salomon, Laurent, Villers, Arnaud, Soulie, Michel, Bellec, Laurent, Rischmann, Pascal, De La Taille, Alexandre, Avakian, Raffi, Crepel, Maxime, Ferriere Jean, Marie, Bernhard Jean, Christophe, Dujardin, Thierry, Pouliot, Frederic, Rigaud, Jerome, Pfister, Christian, Albouy, Baptiste, Guy, Laurent, Joniau, Steven, van Poppel, Hendrik, Lebret, Thierry, Culty, Thibault, Saint, Fabien, Zisman, Amnon, Raz, Orit, Lang, Herve, Spie, Romain, Wille, Andrea, Roigas, Jan, Aguilera, Alfredo, Rambeaud, Bastien, Martinez Pineiro, Lui, Nativ, Ofer, Farfara, Roy, Richard, Francoi, Roupret, Morgan, Doehn, Christian, Bastian Patrick, J., Muller Stefan, C., Tostain, Jacque, Belldegrun Arie, S., Patard Jean, Jacques, Service d'Urologie - Andrologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Université de Toulouse (UT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and University Hospital Bonn

Subjects
Surgical margin, medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Survival Rate, Urology, medicine.medical_treatment, 030232 urology & nephrology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, Predictive Value of Tests, medicine, Humans, Survival rate, Carcinoma, Renal Cell, MESH: Nephrons, Retrospective Studies, MESH: Humans, MESH: Middle Aged, Proportional hazards model, business.industry, Retrospective cohort study, MESH: Retrospective Studies, Nephrons, MESH: Carcinoma, Renal Cell, Middle Aged, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Neoplasms, MESH: Predictive Value of Tests, 3. Good health, Surgery, Survival Rate, MESH: Nephrectomy, 030220 oncology & carcinogenesis, Predictive value of tests, MESH: Kidney Neoplasms, business, Kidney cancer
Abstract

International audience; BACKGROUND: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history. OBJECTIVE: To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN. DESIGN, SETTING, AND PARTICIPANTS: Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade. MEASUREMENTS: PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival. RESULTS AND LIMITATIONS: Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival. CONCLUSIONS: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed.

Published
2010

24. Nephron-sparing Surgery Is Equally Effective to Radical Nephrectomy for T1BN0M0 Renal Cell Carcinoma: A Population-based Assessment

Author

Pierre I. Karakiewicz, Daniel Liberman, Umberto Capitanio, Hugues Widmer, Paul Perrotte, Maxine Sun, Maxime Crepel, Shahrokh F. Shariat, Hendrik Isbarn, Jean Jacques Patard, Claudio Jeldres, Francesco Montorsi, Philippe Arjane, Markus Graefen, Giovanni Lughezzani, Crepel, Maxime, Jeldres, Claudio, Perrotte, Paul, Capitanio, Umberto, Isbarn, Hendrik, Shariat Shahrokh, F., Liberman, Daniel, Sun, Maxine, Lughezzani, Giovanni, Arjane, Philippe, Widmer, Hugue, Graefen, Marku, Montorsi, Francesco, Patard Jean, Jacque, Karakiewicz Pierre, I., Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Cancer Prognostics and Health Outcomes Unit, Department of urology, Università Vita-Salute San Raffaele, Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Division of Urology, Sidney Kimmel Center for Prostate and Urologic Cancer, Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], and De Villemeur, Hervé

Subjects
Adult, Male, Nephrology, medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Urology, medicine.medical_treatment, Population, 030232 urology & nephrology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Young Adult, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, Internal medicine, Carcinoma, Humans, Medicine, education, Carcinoma, Renal Cell, Aged, Neoplasm Staging, Aged, 80 and over, education.field_of_study, business.industry, Nephrons, Middle Aged, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Neoplasms, 3. Good health, Surgery, 030220 oncology & carcinogenesis, Cohort, Female, business, Kidney cancer, Kidney disease
Abstract

OBJECTIVES To test the effect of nephron-sparing surgery (NSS) vs radical nephrectomy (RN) on cancer-specific mortality (CSM) in patients with T1bN0M0 renal cell carcinoma (RCC) in a population-based cohort. To date, only few series from tertiary care centers supported the use of NSS for T1bN0M0 (range 4-7 cm) RCC. METHODS The Surveillance, Epidemiology, and End Results database allowed us to identify 275 NSS (5.3%) and 4866 RN (94.7%) patients treated for T1bN0M0 RCC between 1988 and 2004. Analyses matched for age, year of surgery, tumor size, and Fuhrman grade addressed the effect of nephrectomy type (NSS vs RN) on CSM. RESULTS Five years after surgery, the surviving proportions of NSS and RN patients matched for age, tumor size, and year of surgery were respectively 91.4 and 95.3% and 90.1 and 93.8% in the cohort, where additional matching for Fuhrman grade was performed. Neither of the matched analyses resulted in statistically significant CSM difference (P = .1 and .4) between NSS and RN. Similarly, competing-risks regression analyses based on both matching schemes also failed to reveal statistically significant CSM differences (P = .3 and .3). CONCLUSIONS Our study represents the largest and the only population-based analysis of cancer control efficacy of NSS vs RN in T1bN0M0 RCC. It indicates that NSS does provide equivalent cancer control relative to RN. In consequence, based on cancer control equivalence, NSS should be given equal consideration to RN in patients with T1bN0M0 lesions. UROLOGY 75: 271-276, 2010. Crown Copyright (C) 2010 Published by Elsevier Inc.

Published
2010

25. Conditional survival predictions after nephrectomy for renal cell carcinoma

Author

Laurent Zini, Shahrokh F. Shariat, Jean Luc Descotes, Jean Jacques Patard, Nazareno Suardi, Eric Lechevallier, Denis Chautard, Hendrik Isbarn, Luca Cindolo, Umberto Capitanio, Arnaud Mejean, Jacques Tostain, Arie S. Belldegrun, Antoine Valeri, Allan J. Pantuck, Alexandre de la Taille, Vincenzo Ficarra, Herve Lang, Richard Zigeuner, Paul Perrotte, Peter F.A. Mulders, Claudio Jeldres, Maxine Sun, Pierre I. Karakiewicz, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcomes Unit, Department of urology, Università Vita-Salute San Raffaele, Departement of Oncological and Surgical Sciences, Università degli Studi di Padova = University of Padua (Unipd), Institute of human genetics, Medical University Graz, Service d'Urologie - Andrologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Service d'urologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), G Rummo Hospital, Department of Urology, University of California [Los Angeles] (UCLA), University of California (UC)-University of California (UC), Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Département d'Uro-néphro-endocrinologie, CHU Grenoble-Hôpital Michallon, University of Texas Southwestern Medical Center [Dallas], Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Radboud University Medical Center [Nijmegen], Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service d'urologie et de transplantation rénale, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Universita degli Studi di Padova, Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, University of California-University of California, PRES Université de Toulouse, Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], De Villemeur, Hervé, CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, Université de Montréal, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] ( UJM ) -Hôpital nord, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -CHU Necker - Enfants Malades [AP-HP], University of California at Los Angeles [Los Angeles] ( UCLA ), Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Université d'Angers ( UA ) -CHU Angers, Université de Brest ( UBO ) -Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille ( APHM ), Université de Rennes 1 ( UR1 ), and Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
[ SDV.MHEP.UN ] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Male, Nephrology, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, MESH : Aged, 030232 urology & nephrology, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH : Carcinoma, Renal Cell, 0302 clinical medicine, MESH: Aged, 80 and over, MESH : Child, MESH : Nomograms, Renal cell carcinoma, MESH: Child, MESH : Female, [ SDV.MHEP.CHI ] Life Sciences [q-bio]/Human health and pathology/Surgery, Child, Aged, 80 and over, MESH: Aged, MESH : Prognosis, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, MESH : Adult, Middle Aged, Prognosis, Kidney Neoplasms, 3. Good health, MESH: Young Adult, 030220 oncology & carcinogenesis, MESH: Survival Analysis, Female, Adult, medicine.medical_specialty, Adolescent, MESH : Male, Urology, MESH : Young Adult, MESH: Nomograms, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Prognosis, Young Adult, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Translational research [ONCOL 3], MESH : Adolescent, Internal medicine, medicine, Carcinoma, Humans, MESH : Middle Aged, MESH : Aged, 80 and over, Carcinoma, Renal Cell, Survival analysis, Aged, MESH: Adolescent, MESH: Humans, Proportional hazards model, business.industry, MESH : Humans, MESH : Nephrectomy, MESH: Adult, Nomogram, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Survival Analysis, MESH : Kidney Neoplasms, MESH: Male, Surgery, MESH: Nephrectomy, Nomograms, MESH : Survival Analysis, MESH: Kidney Neoplasms, business, Kidney cancer, MESH: Female
Abstract

Item does not contain fulltext PURPOSE: Conditional survival implies that on average long-term cancer survivors have a better prognosis than do newly diagnosed individuals. We explored the effect of conditional survival in renal cell carcinoma. MATERIALS AND METHODS: We studied 3,560 patients with renal cell carcinoma of all stages treated with nephrectomy. We applied conditional survival methodology to a previously reported posttreatment nomogram predicting survival after nephrectomy for patients with renal cell carcinoma stage I to IV. We used the same predictor variables that were integrated in the original multivariable Cox regression models, namely TNM stage, Fuhrman grade, tumor size and symptom classification. To validate the conditional survival nomogram we used an independent cohort of 3,560 patients from 15 institutions. RESULTS: The 5-year survival of patients immediately after nephrectomy was 74.2%, which increased to 80.4%, 85.1%, 90.6% and 89.6% at 1, 2, 5 and 10 years after nephrectomy, respectively. The predicted probabilities varied by as much as 50% when, for example, predictions of renal cell carcinoma specific mortality at 10 years were made after nephrectomy vs 5 years later. Within the external validation cohort the accuracy of the conditional nomogram was 89.5%, 90.5%, 88.5% and 86.7% at 1, 2, 5 and 10 years after nephrectomy. CONCLUSIONS: We developed (2,530) and externally validated (3,560) a conditional nomogram for predicting renal cell carcinoma specific mortality that allows consideration of the length of survivorship. Our tool provides the most realistic prognosis estimates with high accuracy.

Published
2009

26. A Proposal for Reclassification of the Fuhrman Grading System in Patients with Clear Cell Renal Cell Carcinoma

Author

Mathieu Latour, Hugues Widmer, Maxine Sun, Daniel Pharand, Hendrik Isbarn, Claudio Jeldres, Pierre I. Karakiewicz, Paul Perrotte, Giovanni Lughezzani, Jean Jacques Patard, Shahrokh F. Shariat, Philippe Arjane, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Department of Urology, Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie] (UniSR), Cancer Prognostics and Health Outcomes Unit, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], De Villemeur, Hervé, Service d'urologie [Rennes], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
Male, Clear cell renal cell carcinoma, Time Factors, medicine.medical_treatment, 030232 urology & nephrology, Kaplan-Meier Estimate, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 0302 clinical medicine, Renal cell carcinoma, Risk Factors, Medicine, Grading (education), health care economics and organizations, Aged, 80 and over, Observer Variation, education.field_of_study, Middle Aged, Prognosis, Classification, Kidney Neoplasms, 3. Good health, Treatment Outcome, 030220 oncology & carcinogenesis, Clear cell carcinoma, Female, Radiology, medicine.medical_specialty, Urology, Population, education, [SDV.CAN]Life Sciences [q-bio]/Cancer, Risk Assessment, Disease-Free Survival, Decision Support Techniques, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, health services administration, Terminology as Topic, Humans, Mortality, Carcinoma, Renal Cell, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, business.industry, Proportional hazards model, Reproducibility of Results, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, United States, Surgery, Fuhrman grade, business, Kidney cancer, SEER Program
Abstract

International audience; BACKGROUND: The conventional Fuhrman grading system, which categorizes renal cell carcinoma (RCC) with grades I, II, III, and IV, is the most widely used predictor assessment of RCC cancer-specific mortality (CSM). OBJECTIVES: The aim of this study was to test the prognostic ability of simplified Fuhrman grading schemes (FGSs) that rely on two- or three-tiered classifications. DESIGN, SETTING, AND PARTICIPANTS: The current study addressed a population of 14064 patients with clear cell RCC who were treated with partial or radical nephrectomy between 1988-2004, within nine Surveillance, Epidemiology, and End Results (SEER) cancer registries. MEASUREMENTS: Univariable and multivariable analyses as well as prognostic accuracy analyses were performed for various FGSs to test their ability to predict CSM rates. The conventional four-tiered FGS was compared to a modified two-tiered FGS in which grades I and II and grades III and IV were combined. A second simplified three-tiered FGS in which grades I and II were combined but grades III and IV were kept separate was also tested. RESULTS AND LIMITATIONS: The overall 5-yr CSM-free rate was 81.5%. All three FGSs achieved independent predictor status in multivariable analyses. Prognostic accuracy of multivariable models that relied on various FGSs was 83.6% for the modified two-tiered FGS and 83.8% for both the conventional four-tiered and the modified three-tiered FGS. CONCLUSIONS: Our findings indicate that the simplified FGSs perform equally as well as the conventional four-tiered FGS. The use of simplified grading schemes may represent an advantage for pathologists as well as for clinicians caring for patients with RCC.

Published
2009

27. Tumor size is a determinant of the rate of stage T1 renal cell cancer synchronous metastasis

Author

Maxine Sun, Philippe Arjane, Pierre I. Karakiewicz, Hugues Widmer, Paul Perrotte, Jean Jacques Patard, Hendrik Isbarn, Daniel Pharand, Shahrokh F. Shariat, Francesco Montorsi, Markus Graefen, Giovanni Lughezzani, François Péloquin, Claudio Jeldres, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Department of urology, Università Vita-Salute San Raffaele, Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Cancer Prognostics and Health Outcomes Unit, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Lughezzani, Giovanni, Jeldres, Claudio, Isbarn, Hendrik, Perrotte, Paul, Shariat Shahrokh, F., Sun, Maxine, Widmer, Hugue, Arjane, Philippe, Peloquin, Francoi, Pharand, Daniel, Patard Jean, Jacque, Graefen, Marku, Montorsi, Francesco, Karakiewicz Pierre, I., Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and De Villemeur, Hervé

Subjects
Adult, Male, Pathology, medicine.medical_specialty, Adolescent, Urology, medicine.medical_treatment, 030232 urology & nephrology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Chromophobe cell, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Metastasis, Young Adult, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Risk Factors, Renal cell carcinoma, Surveillance, Epidemiology, and End Results, Carcinoma, Humans, Medicine, Carcinoma, Renal Cell, Aged, Neoplasm Staging, Aged, 80 and over, business.industry, Cancer, Middle Aged, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Neoplasms, Nephrectomy, 3. Good health, 030220 oncology & carcinogenesis, Female, business, Kidney cancer
Abstract

International audience; PURPOSE: A recent multi-institutional analysis of 995 patients treated for renal cell cancer questioned the relationship between tumor size and the synchronous metastasis rate. We revisited the hypothesis that metastatic potential is unrelated to tumor size. MATERIALS AND METHODS: We tested the relationship between tumor size and synchronous metastasis in 22,204 patients with T1a and T1b renal cell cancer diagnosed and/or treated with nephrectomy for clear cell, papillary or chromophobe histological subtypes in 1 of 9 Surveillance, Epidemiology and End Results registries between 1988 and 2004. RESULTS: In the study population the synchronous metastasis rate was 9.6%, including 5.6% vs 14.2% for T1a vs T1b. Stratification by 1 cm tumor size intervals revealed that the rate increased with increasing tumor size, that is 4.8% at 1.0 cm or less, 4.2% at 1.1 to 2.0 cm, 4.9% at 2.1 to 3.0 cm, 7.1% at 3.1 to 4.0 cm, 12.1% at 4.1 to 5.0 cm, 13.3% at 5.1 to 6.0 cm and 18.4% 6.1 to 7.0 cm (chi-square trend p

Published
2009

28. The use of partial nephrectomy in European tertiary care centers

Author

A. De La Taille, L. Salomon, Maxime Crepel, Jacques Biserte, Laurent Zini, Umberto Capitanio, F. Montorsi, Pierre I. Karakiewicz, Gregory Verhoest, A. Mejean, Roberto Bertini, J.J. Patard, Paul Perrotte, Karim Bensalah, Vincenzo Ficarra, Philippe Arjane, A. Villers, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Department of urology, Università Vita-Salute San Raffaele, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'urologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Department of Oncological and Surgical Sciences, Università degli Studi di Padova = University of Padua (Unipd), Cancer Prognostics and Health Outcomes Unit, Université de Montréal, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Institut de Génétique et Développement de Rennes ( IGDR ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140-Centre National de la Recherche Scientifique ( CNRS ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -CHU Necker - Enfants Malades [AP-HP], Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Universita degli Studi di Padova, Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Zini, L., Patard, J. J., Capitanio, U., Mejean, A., Villers, A., de La Taille, A., Ficarra, V., Crepel, M., Bertini, R., Salomon, L., Verhoest, G., Perrotte, P., Bensalah, K., Arjane, P., Biserte, J., Montorsi, Francesco, Karakiewicz, P., Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), and De Villemeur, Hervé

Subjects
Male, [ SDV.MHEP.UN ] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Younger age, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, 030232 urology & nephrology, Logistic regression, Tertiary care, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 030218 nuclear medicine & medical imaging, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH : Carcinoma, Renal Cell, 0302 clinical medicine, Renal cell carcinoma, MESH : Female, MESH : Neoplasm Staging, [ SDV.MHEP.CHI ] Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Middle Aged, Tumor size, General Medicine, MESH: Carcinoma, Renal Cell, MESH: Neoplasm Staging, Middle Aged, Kidney Neoplasms, 3. Good health, Europe, Oncology, Female, medicine.medical_specialty, MESH : Male, MESH : Europe, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Humans, MESH : Middle Aged, Quality of care, Carcinoma, Renal Cell, Male gender, Neoplasm Staging, MESH: Humans, business.industry, MESH : Humans, MESH : Nephrectomy, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH : Kidney Neoplasms, MESH: Male, Surgery, MESH: Nephrectomy, MESH: Europe, MESH: Kidney Neoplasms, business, MESH: Female
Abstract

Purpose: The objective was to define the trends of PN use over time at six tertiary care European centers. Methods: Data were retrieved from institutional databases for patients treated with either PN or radical nephrectomy (RN) for stages T(1-2)N(0)M(0) renal cell carcinoma (RCC) between 1987 and 2007. For purpose of temporal trend analyses patients were divided into five equally sized groups according to the date of surgery. Categorical and multivariable logistic regression analyses assessed predictors of PN use. Results: Overall 597 (31.7%) patients were treated with PN. Overall, a 4.5-fold increase of PN was recorded. The absolute increases were 41.7-86.3%, 14.9-69.3% and 8.1-35.3% for lesions

Published
2009

29. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study

Author

Vincent Cloutier, Pierre I. Karakiewicz, Elie Antebi, Francesco Montorsi, Shahrokh F. Shariat, Claudio Jeldres, Jean Jacques Patard, Laurent Zini, Hendrik Isbarn, Paul Perrotte, Umberto Capitanio, Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcomes Unit, Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), De Villemeur, Hervé, Capitanio, Umberto, Cloutier, Vincent, Zini, Laurent, Isbarn, Hendrik, Jeldres, Claudio, Shariat Shahrokh, F., Perrotte, Paul, Antebi, Elie, Patard Jean, Jacque, Montorsi, Francesco, and Karakiewicz Pierre, I.

Subjects
Oncology, Male, Pathology, MESH: Carcinoma, Papillary, medicine.medical_treatment, 030232 urology & nephrology, Chromophobe cell, MESH: Epidemiologic Methods, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Cause of Death, 0302 clinical medicine, MESH: Aged, 80 and over, Renal cell carcinoma, Cause of Death, MESH: Child, Child, Aged, 80 and over, MESH: Aged, education.field_of_study, MESH: Middle Aged, MESH: Neoplasm Staging, MESH: Carcinoma, Renal Cell, Middle Aged, Prognosis, Nephrectomy, Kidney Neoplasms, 3. Good health, MESH: Young Adult, 030220 oncology & carcinogenesis, Child, Preschool, Female, Adult, medicine.medical_specialty, Adolescent, Urology, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Prognosis, 03 medical and health sciences, Young Adult, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Carcinoma, Humans, education, Carcinoma, Renal Cell, Aged, Neoplasm Staging, MESH: Adolescent, MESH: Humans, Proportional hazards model, business.industry, MESH: Child, Preschool, MESH: Adult, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Carcinoma, Papillary, MESH: Male, MESH: Kidney Neoplasms, business, Epidemiologic Methods, Kidney cancer, MESH: Female, Clear cell
Abstract

International audience; OBJECTIVE To assess the magnitude of the effect of histological subtype (HS, the three most common being clear cell, papillary and chromophobe) on cause-specific mortality (CSM) from renal cell carcinoma (RCC). PATIENTS AND METHODS Univariable and multivariable Cox regression models included data from 11 618 patients treated with nephrectomy between 1988 and 2004 in nine Surveillance Epidemiology and End Results registries. We tested whether HS represents an independent predictor of CSM, and whether HS adds to the ability of other variables to predict CSM. The covariates comprised age, year of surgery, T stage, nodal status, M stage and Fuhrman grade. RESULTS In a multivariable model predicting CSM, HS was an independent predictor (P = 0.03), but failed to improve the accuracy of the model (+0.1% gain when HS was included in the model). CONCLUSION Although we confirmed that HS is an independent predictor for CSM, there was no gain in accuracy when HS was added to standard predictors of CSM. From a practical perspective, this implies that patients with clear cell, papillary and chromophobe HS share similar natural histories after nephrectomy, provided that other cancer characteristics are accounted for. From a statistical perspective, in multivariable models of CSM, the clear cell, papillary and chromophobe HS might be included as a single entity.

Published
2009

30. Population-based assessment of survival after cytoreductive nephrectomy versus no surgery in patients with metastatic renal cell carcinoma

Author

Pierre I. Karakiewicz, Paul Perrotte, Shahrokh F. Shariat, Francesco Montorsi, Hugues Widmer, Laurent Zini, Jean Jacques Patard, Philippe Arjane, Claudio Jeldres, Umberto Capitanio, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcomes Unit, Institut de Génétique et Développement de Rennes (IGDR), Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Zini, Laurent, Capitanio, Umberto, Perrotte, Paul, Jeldres, Claudio, Shariat Shahrokh, F., Arjane, Philippe, Widmer, Hugue, Montorsi, Francesco, Patard Jean, Jacque, Karakiewicz Pierre, I., De Villemeur, Hervé, and Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Nephrology, Male, medicine.medical_specialty, MESH: Survival Rate, Urology, medicine.medical_treatment, Population, 030232 urology & nephrology, [SDV.CAN]Life Sciences [q-bio]/Cancer, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, Internal medicine, medicine, Carcinoma, Humans, education, Carcinoma, Renal Cell, Aged, MESH: Aged, education.field_of_study, MESH: Humans, MESH: Middle Aged, Proportional hazards model, business.industry, MESH: Carcinoma, Renal Cell, Middle Aged, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Neoplasms, MESH: Male, 3. Good health, Surgery, Survival Rate, MESH: Nephrectomy, 030220 oncology & carcinogenesis, Female, MESH: Kidney Neoplasms, business, Kidney cancer, MESH: Female, Kidney disease
Abstract

OBJECTIVES To examine the population-based survival rates of patients with metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy (CNT) and compare them with those of patients treated without surgery. METHODS Of the 43 143 patients with RCC identified in the 1988-2004 Surveillance, Epidemiology, and End Results database, 5372 had metastatic RCC. Of those, 2447 were treated with CNT (45.5%) and 2925 (54.5%) were not. Unvariable and multivariable Cox regression models, as well as matched and unmatched Kaplan-Meier survival analyses, were used. The covariates consisted of age, sex, tumor size, and year of diagnosis. RESULTS The 1-, 2-, 5-, and 10-year overall Survival rate of the patients treated with CNT was 53.6%, 36.3%, 19.4%, and 12.7% compared with 18.5%, 7.4%, 2.3%, and 1.2% for the no-surgery patients, respectively. The corresponding cancer-specific survival rates were 58.1%, 40.8%, 24.3%, and 18.8% and 24.4%, 11.0%, 4.1%, and 2.9% for the same patient groups. On multivariate analysis, independent predictor status was recorded for treatment type, tumor size, and patient age (all P < .001). Also, relative to CNT, the no-surgery group had a 2.5-fold greater rate of overall and cancer-specific mortality (P < .001). In the matched analyses, virtually the same effect was recorded (hazard ratio 2.6, P < .001). CONCLUSION The results of our study have shown that CNT significantly improves the survival of patients with metastatic RCC. UROLOGY 73: 342-346, 2009. (C) 2009 Published by Elsevier Inc.

Published
2009

31. A population-based comparison of survival after nephrectomy vs nonsurgical management for small renal masses

Author

Paul Perrotte, Pierre I. Karakiewicz, Laurent Zini, Martine Jolivet-Tremblay, Claudio Jeldres, Arnauld Villers, Francesco Montorsi, Alain Duclos, Philippe Arjane, François Péloquin, Umberto Capitanio, Daniel Pharand, Jean Jacques Patard, Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcomes Unit, Department of urology, Università Vita-Salute San Raffaele, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], De Villemeur, Hervé, Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Zini, Laurent, Perrotte, Paul, Jeldres, Claudio, Capitanio, Umberto, Duclos, Alain, Jolivet Tremblay, Martine, Arjane, Philippe, Peloquin, Francoi, Pharand, Daniel, Villers, Arnauld, Montorsi, Francesco, Patard Jean, Jacque, and Karakiewicz Pierre, I.

Subjects
Nephrology, Male, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, 030232 urology & nephrology, MESH: Epidemiologic Methods, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Nephrectomy, 0302 clinical medicine, Renal cell carcinoma, MESH: Risk Factors, Risk Factors, Cumulative incidence, MESH: Treatment Outcome, MESH: Aged, education.field_of_study, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, Middle Aged, Prognosis, Kidney Neoplasms, 3. Good health, Treatment Outcome, 030220 oncology & carcinogenesis, MESH: Survival Analysis, MESH: SEER Program, Female, medicine.medical_specialty, Urology, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Prognosis, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, MESH: United States, Humans, education, Carcinoma, Renal Cell, Survival analysis, Aged, MESH: Humans, business.industry, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Survival Analysis, MESH: Male, United States, Surgery, MESH: Nephrectomy, MESH: Kidney Neoplasms, business, Epidemiologic Methods, Kidney cancer, MESH: Female, Kidney disease, SEER Program
Abstract

OBJECTIVE To examine population-based rates of cancer-specific and other-cause mortality after either non-surgical management (NSM) or nephrectomy, in patients with small renal masses, as several reports from selected institutions support the applicability of surveillance in patients with small renal masses, but there are no population-based studies confirming the general applicability of this therapy. PATIENTS AND METHODS Of 43 143 patients with renal cell carcinoma identified in the 1988–2004 Surveillance, Epidemiology and End Results database, 10 291 had localized small renal masses (≤4 cm) and were offered NSM (433, 4.2%) or nephrectomy (9858, 95.8%). Univariable matched and multivariable unmatched competing-risks regression models were used in the analyses. RESULTS Cumulative incidence plots based on unmatched data, where the effect of other-cause mortality was controlled for, showed a 5.2%, 6.5% and 9.4% survival benefit for nephrectomy vs NSM at 1, 2 and 5 years after nephrectomy or diagnosis, respectively. The same magnitude of the benefit (4.5%, 5.6% and 8.0%) persisted in analyses matched for age, tumour size and year of diagnosis or of nephrectomy. Finally, in multivariable analyses, treatment type, age, tumour size and year of diagnosis or of nephrectomy were independent predictors. CONCLUSION Relative to nephrectomy, NSM appears to undermine the overall and cancer-specific survival of patients with small renal masses by as much as 9.4%, at 5 years.

Published
2009

32. Race affects access to nephrectomy but not survival in renal cell carcinoma

Author

Alain Duclos, Arnauld Villers, Philippe Arjane, Laurent Zini, Paul Perrotte, Umberto Capitanio, Jean Jacques Patard, Claudio Jeldres, Francesco Montorsi, Pierre I. Karakiewicz, De Villemeur, Hervé, Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcomes Unit, Department of urology, Università Vita-Salute San Raffaele, Département d'urologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Zini, Laurent, Perrotte, Paul, Capitanio, Umberto, Jeldres, Claudio, Duclos, Alain, Arjane, Philippe, Villers, Arnauld, Montorsi, Francesco, Patard Jean, Jacque, and Karakiewicz Pierre, I.

Subjects
Male, medicine.medical_treatment, 030232 urology & nephrology, Logistic regression, MESH: Epidemiologic Methods, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Health Services Accessibility, 0302 clinical medicine, Renal cell carcinoma, 10. No inequality, MESH: Aged, MESH: Health Services Accessibility, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, MESH: European Continental Ancestry Group, Middle Aged, Kidney Neoplasms, 3. Good health, 030220 oncology & carcinogenesis, MESH: Survival Analysis, Cohort, MESH: SEER Program, Female, medicine.medical_specialty, Urology, Black People, [SDV.CAN]Life Sciences [q-bio]/Cancer, White People, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Humans, Carcinoma, Renal Cell, Aged, MESH: Humans, Proportional hazards model, business.industry, medicine.disease, Comorbidity, Survival Analysis, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Male, Surgery, MESH: Nephrectomy, MESH: African Continental Ancestry Group, MESH: Kidney Neoplasms, business, Epidemiologic Methods, Kidney cancer, MESH: Female, Kidney disease, SEER Program
Abstract

International audience; OBJECTIVES: To assess whether, in contemporary patients with renal cell carcinoma (RCC), access to nephrectomy is the same between the Blacks and Whites, and that there is no difference in mortality after stratification for treatment type. PATIENTS AND METHODS: The effect of race has received little attention in RCC; only two reports have addressed and suggested the presence of racial disparities, including access to nephrectomy and survival after nephrectomy, where Black patients were disadvantaged relative to Whites. We used the Surveillance, Epidemiology and End Results data from 12 516 patients of all stages diagnosed and treated for RCC between 2000 and 2004. The effect of race (Black vs White) on nephrectomy rate was addressed in logistic regression and binomial regression models, and Cox regression models tested the effect of race on overall survival. RESULTS: Black patients were 50% less likely to have a nephrectomy than their White counterparts. However, race had no effect on overall survival when the entire cohort was assessed, as well as in subgroups of patients with or without nephrectomy. CONCLUSIONS: Although race is a determinant of access to nephrectomy, it should not be interpreted as a barrier to care, as survival was unaffected by race in patients having a nephrectomy or not. Instead, race might represent a proxy of comorbidity and life-expectancy, which represent surgical selection criteria for nephrectomy.

Published
2009

33. Thirty-day mortality after nephrectomy: clinical implications for informed consent

Author

Umberto Capitanio, Laurent Zini, Pierre I. Karakiewicz, Jean Jacques Patard, Philippe Arjane, Vincent Cloutier, Paul Perrotte, Francesco Montorsi, Shahrokh F. Shariat, Claudio Jeldres, De Villemeur, Hervé, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcomes Unit, Department of urology, Università Vita-Salute San Raffaele, Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Cloutier, Vincent, Capitanio, Umberto, Zini, Laurent, Perrotte, Paul, Jeldres, Claudio, Shariat Shahrokh, F., Arjane, Philippe, Patard Jean, Jacque, Montorsi, Francesco, and Karakiewicz Pierre, I.

Subjects
Male, Time Factors, medicine.medical_treatment, 030232 urology & nephrology, MESH: Logistic Models, Logistic regression, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Cohort Studies, 0302 clinical medicine, MESH: Aged, 80 and over, Informed consent, Risk Factors, MESH: Risk Factors, Epidemiology, MESH: Informed Consent, Stage (cooking), MESH: Cohort Studies, Aged, 80 and over, MESH: Aged, Informed Consent, MESH: Middle Aged, Middle Aged, Kidney Neoplasms, MESH: Predictive Value of Tests, 3. Good health, 030220 oncology & carcinogenesis, Predictive value of tests, Cohort, MESH: SEER Program, Female, Cohort study, medicine.medical_specialty, Urology, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, medicine, Humans, Aged, MESH: Humans, business.industry, MESH: Time Factors, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Male, Surgery, MESH: Nephrectomy, Logistic Models, MESH: Kidney Neoplasms, business, MESH: Female, SEER Program
Abstract

Background: The existing literature suggests that the surgical mortality (SM) observed with nephrectomy for localised disease varies from 0.6% to 3.6%. Objective: To examine age-and stage-specific 30-d mortality (TDM) rates after partial or radical nephrectomy. Design, setting, and participants: We relied on 24 535 assessable patients from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database. Measurements: In 12 283 patients, logistic regression models were used to develop a tool for pretreatment prediction of the probability of TDM according to individual patient and tumour characteristics. External validation was performed on 12 252 patients. Results and limitations: In the entire cohort of 24 535 patients, 219 deaths occurred during the initial 30 d after nephrectomy (0.9% TDM rate). TDM increased with age (= 80 yr: 2.0%; chi(2) trend p < 0.001) and stage (0.3% for T1-2N0M0 vs 1.3% for T3-4N0-2M0 vs 4.2% for T1-4N0-2M1; chi(2) trend p =

Published
2009

34. Does histologic subtype affect oncologic outcomes after nephron-sparing surgery?

Author

Shahrokh F. Shariat, Claudio Jeldres, Philippe Arjane, Umberto Capitanio, Pierre I. Karakiewicz, Francesco Montorsi, Hendrik Isbarn, Paul Perrotte, Daniel Liberman, Markus Graefen, Hugues Widmer, Maxine Sun, Maxime Crepel, Jean Jacques Patard, De Villemeur, Hervé, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Department of Urology, Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie] (UniSR), Cancer Prognostics and Health Outcomes Unit, Division of Urology, Sidney Kimmel Center for Prostate and Urologic Cancer, Department of urology, Università Vita-Salute San Raffaele, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Crepel, Maxime, Isbarn, Hendrik, Capitanio, Umberto, Liberman, Daniel, Jeldres, Claudio, Sun, Maxine, Shariat Shahrokh, F., Widmer, Hugue, Arjane, Philippe, Graefen, Marku, Montorsi, Francesco, Patard Jean, Jacque, Perrotte, Paul, Karakiewicz Pierre, I., Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)

Subjects
Male, Pathology, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, 030232 urology & nephrology, Chromophobe cell, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 0302 clinical medicine, MESH: Aged, 80 and over, Renal cell carcinoma, Stage (cooking), MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, MESH: Carcinoma, Renal Cell, Middle Aged, Kidney Neoplasms, 3. Good health, Survival Rate, Treatment Outcome, MESH: Young Adult, 030220 oncology & carcinogenesis, Female, Adult, medicine.medical_specialty, Adolescent, MESH: Survival Rate, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 03 medical and health sciences, Young Adult, [SDV.CAN] Life Sciences [q-bio]/Cancer, medicine, Carcinoma, Humans, Survival rate, Carcinoma, Renal Cell, MESH: Nephrons, Aged, MESH: Adolescent, MESH: Humans, business.industry, Proportional hazards model, MESH: Adult, Nephrons, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Male, MESH: Nephrectomy, MESH: Kidney Neoplasms, business, MESH: Female, Clear cell
Abstract

OBJECTIVES To test whether renal cell carcinoma (RCC) histologic subtypes (HSs) affect cancer-specific mortality after nephron-sparing surgery (NSS). HSs are considered of prognostic value in RCC. For example, the papillary HS might confer a worse prognosis, and, at some centers, only radical nephrectomy is per-formed for the papillary HS. METHODS We used Univariate and multivariate Cox regression models to study patients with Stage T1N0M0 RCC treated with NSS (n = 1205) from 1988 to 2004. The data were taken from 9 Surveillance, Epidemiology, and End Results registries. RESULTS At 36 months after NSS, the cancer-specific mortality rate was 97.8%, 100%, and 97.4% for a clear cell, chromophobe, and papillary RCC HS, respectively. On Univariate and multivariate analyses, no statistically significant differences were recorded with regard to the HS. CONCLUSIONS Despite the suggested more aggressive phenotype of the papillary HS, we found no difference among the papillary, chromophobe, and clear cell variants. Thus, the diagnosis of one HS vs another HS should not deter from the use of NSS when cancer-specific mortality is considered as an endpoint. UROLOGY 74: 842-845, 2009. Crown Copyright (C) 2009 Published by Elsevier Inc.

Published
2009

35. Age at diagnosis is a determinant factor of renal cell carcinoma-specific survival in patients treated with nephrectomy

Author

Arnaud Mejean, Luigi Schips, Umberto Capitanio, Paul Perrotte, Eric Lechevallier, Laurent Salomon, Vincenzo Ficarra, Jean Jacques Patard, Jacques Tostain, Alexandre de la Taille, Peter F.A. Mulders, Pierre I. Karakiewicz, Nazareno Suardi, Luca Cindolo, Antoine Valeri, Hervé Lang, Gregory Verhoest, Denis Chautard, G.C. Hutterer, Richard Zigeuner, Claudio Jeldres, Jean Luc Descots, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcome Unit, Department of Urology, Medical University Graz, Department of Oncological and Surgical Sciences, Universita degli Studi di Padova, San Pio da Pietrelcina Hospital, Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Radboud University Medical Center [Nijmegen], Service d'urologie, Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Comité de Cancérologie (CCAFU), Association Française d'Urologie, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], De Villemeur, Hervé, and Università degli Studi di Padova = University of Padua (Unipd)

Subjects
medicine.medical_specialty, renal cell carcinoma, Multivariate analysis, Urology, medicine.medical_treatment, 030232 urology & nephrology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Metastasis, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, Translational research [ONCOL 3], Internal medicine, medicine, Stage (cooking), Molecular diagnosis, prognosis and monitoring [UMCN 1.2], Original Research, Proportional hazards model, business.industry, Cancer, prognostic factors, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Nephrectomy, 3. Good health, Surgery, Oncology, 030220 oncology & carcinogenesis, Cohort, business
Abstract

Item does not contain fulltext OBJECTIVE: Based on combined data for 4880 patients, 2 previous studies reported that advanced age is a predictor of increased renal cell carcinoma-specific mortality (RCC-SM). We explored the effect of age in cubic spline analyses to identify the age groups with the most elevated risk for renal cell carcinoma (RCC). METHODS: Our study included 3595 patients from 14 European centres who had partial or radical nephrectomies. We used the Kaplan-Meier method to compile life tables, and we performed Cox regression analyses to assess RCC-SM. Covariates included age at diagnosis, sex, TNM (tumour, node, metastasis) stage, tumour size, Fuhrman grade, symptom classification and histological subtype. RESULTS: Age ranged from 10 to 89 (mean 63, median 67) years. The median duration of follow-up was 2.9 years. The median survival for the cohort was 13.4 years. Stage distribution was as follows: 1915 patients (53.3%) had stage I disease, 388 (10.8%) had stage II, 895 (24.9%) had stage III and 397 (11.0%) had stage IV disease. In multivariate analyses, we coded age at diagnosis as a cubic spline, and it achieved independent predictor status (p < 0.001). The risk of RCC-SM was lowest among patients younger than 50 years. We observed an increase in RCC-SM until the age of 50, at which point the level of risk reached a plateau. We observed a second increase among patients aged 75-89 years. We found similar patterns when we stratified patients according to the 2002 American Joint Committee on Cancer (AJCC) stages. CONCLUSION: The effect of age shows prognostic significance and indicates that follow-up and possibly secondary treatments might need to be adjusted according to the age of the patient.

Published
2008

36. Cytoreductive partial nephrectomy does not undermine cancer control in metastatic renal cell carcinoma: a population-based study

Author

Laurent Zini, Daniel Pharand, François Péloquin, Umberto Capitanio, Pierre I. Karakiewicz, Paul Perrotte, Francesco Montorsi, Philippe Arjane, Claudio Jeldres, Jean Jacques Patard, Hugues Widmer, Shahrokh F. Shariat, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Department of urology, Università Vita-Salute San Raffaele, Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cancer Prognostics and Health Outcomes Unit, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Capitanio, Umberto, Zini, Laurent, Perrotte, Paul, Shariat Shahrokh, F., Jeldres, Claudio, Arjane, Philippe, Pharand, Daniel, Widmer, Hugue, Peloquin, Francoi, Montorsi, Francesco, Patard Jean, Jacque, Karakiewicz Pierre, I., and De Villemeur, Hervé

Subjects
Male, Oncology, medicine.medical_treatment, 030232 urology & nephrology, Kaplan-Meier Estimate, Nephrectomy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Cohort Studies, 0302 clinical medicine, MESH: Aged, 80 and over, Renal cell carcinoma, MESH: Kaplan-Meiers Estimate, MESH: Cohort Studies, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, education.field_of_study, MESH: Middle Aged, Hazard ratio, MESH: Carcinoma, Renal Cell, Middle Aged, Kidney Neoplasms, 3. Good health, Survival Rate, Treatment Outcome, 030220 oncology & carcinogenesis, MESH: SEER Program, Female, medicine.medical_specialty, MESH: Survival Rate, Urology, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, MESH: United States, Humans, education, Carcinoma, Renal Cell, Survival rate, Aged, Retrospective Studies, Gynecology, MESH: Humans, business.industry, Proportional hazards model, MESH: Retrospective Studies, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, United States, MESH: Male, Log-rank test, MESH: Nephrectomy, MESH: Kidney Neoplasms, business, Kidney cancer, MESH: Female, SEER Program
Abstract

OBJECTIVES We examined the poputation-based rates of cancer-specific survival in patients with metastatic renal cell carcinoma (MRCC) treated with either partial (PN) or radical cytoreductive nephrectomy (RN). METHODS Patients diagnosed with MRCC and treated with either PN or RN were identified within nine SEER cancer registries. Matched and unmatched Kaplan-Meier survival analyses, as well as multivariable Cox regression models compared the effect of RN (n = 1997, 97.8%) vs. PN (n = 46, 2.2%) on cancer-specific survival (CSS). Covariates consisted of age, gender, community type (rural vs urban), race, Surveillance, Epidemiology, and End Results (SEER) registry, tumor size and year of diagnosis. RESULTS In multivariable unmatched Cox regression analyses, no statistically significantly difference was found in CSS between the two groups (hazard ratio [HR] 1.40, P = .16). Similarly, no difference in CSS was found in the matched analyses (HR 1.35, log rank P = .34). CONCLUSION Cytoreductive PN does not appear to undermine survival in patients with MRCC. UROLOGY 72: 1090-1095, 2008. (C) 2008 Elsevier Inc.

Published
2008

38. [Sex-specific differences in surgical confidence: results of the Endo Workshop of the German Society of Residents in Urology 2022].

Author

Siech C, Kluth LA, Konopka M, Reimann M, Plage H, Lichy I, Gerdes B, Kasperek J, Humke C, Marks P, Fisch M, Karakiewicz PI, Chun FKH, Schäfer T, Meyer CP, and Kaulfuss JC

Subjects
Humans, Female, Male, Germany, Prospective Studies, Adult, Sex Factors, Urologic Surgical Procedures education, Societies, Medical, Simulation Training methods, Internship and Residency, Urology education, Clinical Competence
Abstract

Background: Simulation-based training is gaining importance in urologic residents training., Objectives: This prospective study evaluated the influence of the Endo Workshop of the German Society of Residents in Urology e. V. (GeSRU) on surgical confidence., Materials and Methods: GeSRU Endo Workshop 2022 included 1 h simulation-based training sessions on stone removal using ureteroscopy (URS) and transurethral resection of the bladder (TURB). Using an online questionnaire, surgical confidence was assessed before and after the workshop. Surgical assessment relied on the global rating scale (GRS)., Results: Overall, 40 residents participated: 25 (62.5%) men and 15 (37.5%) women. In URS assessment, men vs. women achieved an average of 26.6 vs. 26.1/35 points on the GRS (p = 0.7) and completed the task in 8.1 ± 1.9 vs. 9.9 ± 0.4 min (p < 0.001). In TURB assessment, men vs. women achieved an average of 26.0 vs. 27.3/35 points on the GRS (p = 0.3) and required 7.6 ± 1.9 vs. 7.7 ± 2.2 min (p = 0.9), respectively. Among participants who answered the baseline survey and the evaluation (n = 33), 16 (80%) men vs. 3 (23%) women had surgical confidence to perform URS before (p = 0.01), and 19 (95%) men vs. 7 (54%) women after the workshop (p = 0.03). Regarding the performance of TURB, 10 (50%) men vs. 7 (54%) women reported surgical confidence before (p = 0.1), and 15 (75%) men vs. 10 (77%) women after the workshop (p = 1.0). An increase in surgical confidence to perform URS and TURB was reported by 9 (45%) and 10 (50%) men and 9 (69%) and 8 (62%) women, respectively., Conclusions: Endourologic simulation-based training increases surgical confidence of both female and male residents. Despite comparable surgical outcomes, women approach URS with lower surgical confidence compared to their male counterparts., (© 2024. The Author(s).)

Published
2024
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39. ASO Author Reflections: Survival Benefit of Adjuvant Systemic Therapy After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma.

Author

Di Bello F, Jannello LMI, Siech C, de Angelis M, Rodriguez Peñaranda N, Tian Z, Goyal JA, Ruvolo CC, Califano G, Creta M, Morra S, Saad F, Shariat SF, de Cobelli O, Briganti A, Chun FKH, Puliatti S, Longo N, and Karakiewicz PI

Subjects
Humans, Survival Rate, Chemotherapy, Adjuvant, Carcinoma, Transitional Cell surgery, Carcinoma, Transitional Cell mortality, Carcinoma, Transitional Cell pathology, Prognosis, Urologic Neoplasms surgery, Urologic Neoplasms mortality, Urologic Neoplasms pathology, Nephroureterectomy methods
Published
2024
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41. Mortality rates in radical cystectomy patients with bladder cancer after radiation therapy for prostate cancer.

Author

de Angelis M, Siech C, Di Bello F, Rodriguez Peñaranda N, Goyal JA, Tian Z, Longo N, Chun FKH, Puliatti S, Saad F, Shariat SF, Gandaglia G, Moschini M, Longoni M, Montorsi F, Briganti A, and Karakiewicz PI

Abstract

Objective: To conduct a population-based study examining cancer-specific mortality (CSM) and other-cause mortality (OCM) differences in patients with radiation-induced secondary bladder cancer (RT-BCa) vs those with primary bladder cancer (pBCa) undergoing radical cystectomy (RC)., Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with T 2-4 N 0-3 M 0 bladder cancer treated with RC, who had previously been treated with external beam radiation therapy (EBRT) or brachytherapy for prostate cancer, as well as patients with T 2-4 N 0-3 M 0 pBCa treated with RC. Cumulative incidence plots and multivariable competing risks regression (CRR) models were used to assess CSM after additional adjustment for OCM. The same methodology was then repeated based on organ-confined (OC: T 2 N 0 M 0 ) and non-organ-confined (NOC: T 3-4 and/or N 1-3 ) disease., Results: Of 9957 RC patients, RT-BCa was identified in 347 (3%) compared with 9610 (97%) who had pBCa. In multivariable CRR models, no CSM differences were recorded in the overall comparison (P = 0.8), nor in sub-groups based on OC and NOC disease (P = 0.8 and 0.7, respectively). Conversely, multivariable CRR models identified RT-BCa as an independent predictor of 1.3-fold higher OCM in the overall cohort and of 1.5-fold higher OCM in those with NOC disease. In a sensitivity analysis of patients with NOC disease, EBRT was associated with higher OCM rates (hazard ratio 1.5). By contrast, OCM rates were not different in those with OC disease (P = 0.8)., Conclusion: Our study showed that RC for RT-BCa was associated with similar CSM rates as RC for pBCa, regardless of disease stage. However, patients who had undergone EBRT exhibited significantly higher OCM in the NOC sub-group., (© 2024 BJU International.)

Published
2024
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42. Oncological Outcomes of Active Surveillance versus Surgery or Ablation for Patients with Small Renal Masses: A Systematic Review and Quantitative Analysis.

Author

Tsuboi I, Rajwa P, Campi R, Miszczyk M, Fazekas T, Matsukawa A, Kardoust Parizi M, Schulz RJ, Mancon S, Cadenar A, Laukhtina E, Kawada T, Katayama S, Iwata T, Bekku K, Wada K, Karakiewicz PI, Remzi M, Araki M, and Shariat SF

Abstract

Background and Objective: While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions., Methods: In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis., Key Findings and Limitations: We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study., Conclusions and Clinical Implications: Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS., Patient Summary: For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2024
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43. Life Expectancy in High-Grade Incidental Prostate Cancer Patients Versus Population-Based Controls According to Treatment Type.

Author

Di Bello F, Jannello LMI, Baudo A, de Angelis M, Siech C, Tian Z, Goyal JA, Creta M, Califano G, Celentano G, Acquati P, Saad F, Shariat SF, Carmignani L, de Cobelli O, Briganti A, Chun FKH, Longo N, and Karakiewicz PI

Abstract

Objective: To quantify the differences in 5-year overall survival (OS) between high-grade (Gleason sum 8-10) incidental prostate cancer (IPCa) patients and age-matched male population-based controls, according to treatment type: no active versus active treatment., Materials and Methods: We relied on the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) to identify not actively treated and actively treated high-grade IPCa patients. For each case, we simulated an age-matched male control (Monte Carlo simulation), relying on Social Security Administration Life Tables (2004-2020) with 5 years of follow-up. Additionally, we relied on Kaplan-Meier plots to display OS for each treatment type. Multivariable Cox regression models were fitted to predict overall mortality (OM)., Results: Of 564 high-grade IPCa patients, 345 (61%) were not actively treated versus 219 (39%) were actively treated, either with radical prostatectomy or radiotherapy. Median OS was 3 years for not actively treated high-grade IPCa patients, with OS difference at 5 years follow-up of 27% relative to their age-matched male population-based controls (37% vs. 64%). Median OS was 8 years for actively treated high-grade IPCa patients, with OS difference at 5 years follow-up of 6% relative to their age-matched male population-based controls (68% vs. 74%). In the multivariable Cox regression model, active treatment independently predicted lower OM (hazard ratio = 0.6; 95% confidence interval = 0.4-0.8; p < 0.001)., Conclusion: Relative to Life Tables' derived age-matched male controls, not actively treated high-grade IPCa patients exhibit drastically worse OS than their actively treated counterparts. These observations may encourage clinicians to consider active treatment in newly diagnosed high-grade IPCa patients., (© 2024 Wiley Periodicals LLC.)

Published
2024
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44. Neoadjuvant chemotherapy before radical cystectomy in patients with organ-confined and non-organ-confined urothelial carcinoma.

Author

de Angelis M, Jannello LMI, Siech C, Baudo A, Di Bello F, Goyal JA, Tian Z, Longo N, de Cobelli O, Chun FKH, Saad F, Shariat SF, Carmignani L, Gandaglia G, Moschini M, Montorsi F, Briganti A, and Karakiewicz PI

Abstract

Introduction: Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is guideline-recommended in patients with cT2-T4N0M0 urothelial carcinoma of urinary bladder (UCUB). However, no population-based study validated the survival benefit of NAC recorded in clinical trials in a stage-specific fashion. We addressed this knowledge gap., Methods: Within the Surveillance, Epidemiology, and End Results database (2007-2020), we identified patients with cT2-T4N0M0 UCUB treated with NAC before RC versus RC alone. Cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. Survival analyses were performed according to organ confined (OC: cT2N0M0) versus nonorgan confined stages (NOC: cT3-T4N0M0)., Results: Of 3,743 assessable patients, 1,020 (27%) underwent NAC versus 2,723 (73%) RC alone. NAC rates increased over time in OC stage (EAPC = 11.9%, P < 0.001) and NOC stage (EAPC = 8.6%, P < 0.001). In OC stage, cumulative incidence plots derived 5-year CSM was 15.6% in NAC and 19.9% in RC alone patients (P = 0.008). In multivariable CRR models, NAC independently predicted lower CSM (hazard ratio (HR): 0.74, P = 0.01). Similarly, in NOC stage, cumulative incidence plots derived 5-year CSM was 36.1% in NAC and 46.0% in RC alone patients (P = 0.01). In multivariable CRR models, NAC independently predicted lower CSM (HR: 0.66, P < 0.001)., Conclusion: NAC is associated with improved CSM compared to RC alone, both in OC and NOC stages. Specifically, the magnitude of the protective NAC effect was greater in NOC than OC patients. Thus, NAC should always be administered in all eligible patients before RC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Published
2024
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45. The European Network for the Study of Adrenal Tumors Staging System (2015): A United States Validation.

Author

Jannello LMI, Incesu RB, Morra S, Scheipner L, Baudo A, de Angelis M, Siech C, Tian Z, Goyal JA, Luzzago S, Mistretta FA, Ferro M, Saad F, Shariat SF, Chun FKH, Briganti A, Tilki D, Ahyai S, Carmignani L, Longo N, de Cobelli O, Musi G, and Karakiewicz PI

Subjects
Humans, United States epidemiology, Male, Female, Middle Aged, Aged, Adult, Prognosis, Adrenal Gland Neoplasms pathology, Adrenal Gland Neoplasms mortality, Adrenal Gland Neoplasms epidemiology, Europe epidemiology, Neoplasm Staging, SEER Program, Adrenocortical Carcinoma pathology, Adrenocortical Carcinoma mortality, Adrenocortical Carcinoma diagnosis, Adrenal Cortex Neoplasms pathology, Adrenal Cortex Neoplasms mortality, Adrenal Cortex Neoplasms diagnosis
Abstract

Objective: To test the ability of the 2015 modified version of the European Network for the Study of Adrenal Tumors staging system (mENSAT) in predicting cancer-specific mortality (CSM), as well as overall mortality (OM) in adrenocortical carcinoma (ACC) patients of all stages, in a large-scale, and contemporary United States cohort., Methods: We relied on the Surveillance, Epidemiology, and End Results (SEER) database (2004-2020) to test the accuracy and calibration of the mENSAT and subsequently compared it to the 8th edition of the American Joint Committee on Cancer staging system (AJCC)., Results: In 858 ACC patients, mENSAT accuracy was 74.7% for 3-year CSM predictions and 73.8% for 3-year OM predictions. The maximum departures from ideal predictions in mENSAT were +17.2% for CSM and +11.8% for OM. Conversely, AJCC accuracy was 74.5% for 3-year CSM predictions and 73.5% for 3-year OM predictions. The maximum departures from ideal predictions in AJCC were -6.7% for CSM and -7.1% for OM., Conclusion: The accuracy of mENSAT is virtually the same as that of AJCC in predicting CSM (74.7% vs 74.5%) and OM (73.7% vs 73.5%). However, calibration is lower for mENSAT than for AJCC. In consequence, no obvious benefit appears to be associated with the use of mENSAT relative to AJCC in US ACC patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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46. Critical care therapy and in-hospital mortality after radical nephroureterectomy for nonmetastatic upper urinary tract carcinoma.

Author

Di Bello F, Siech C, de Angelis M, Rodriguez Peñaranda N, Tian Z, Goyal JA, Collà Ruvolo C, Califano G, Creta M, Saad F, Shariat SF, Briganti A, Chun FKH, Puliatti S, Longo N, and Karakiewicz PI

Abstract

Background: Use of critical care therapies (CCT), that include invasive mechanical ventilation (IMV), total parenteral nutrition (TPN) and other modalities are unknown after radical nephroureterectomy (RNU) for upper urinary tract carcinoma (UUTC). Their relationship with in-hospital mortality is also unknown., Methods: Within the National Inpatient Sample (2008-2019), we identified non-metastatic UUTC patients treated with RNU. Multivariable logistic regression models were used., Results: Of 8,995 patients, 375 (4.2%) received CCT and 82 (0.9%) experienced in-hospital mortality. Of CCT modalities, 215 (2.4%) received IMV and 139 (1.5%) TPN. Temporal CCT, IMV, and TPN trends very closely followed in-hospital mortality trends. Relative to historical UUTC patients (2008-2013), contemporary (2014-2019) patients exhibited lower CCT (Δ = 2.2%, P value < 0.0001), lower IMV (Δ = 1.4%, P < 0.0001), lower TPN (Δ = 2.2%, P < 0.0001), and lower in-hospital mortality (Δ = 0.4%, P = 0.03) rates. Of in-hospital mortalities, 52 out of 82 received CCT but 30 of 82 did not. Median age (> 72 years; odds ratio [OR] 1.4; P = 0.002) and Charlson comorbidity index ≥ 3 (OR 4.1; P < 0.001) and ≥ 1-2 (OR 1.7; P = 0.001) independently predicted overall higher CCT, IMV, TPN, and in-hospital mortality., Conclusion: After RNU, CCT rates parallels in-hospital mortality rates. CCT represents a 5 to 6-fold multiple of in-hospital mortality rate. In RNU patients, CCT rates are higher in older and sicker individuals. Lower CCT rates that are paralleled by lower in-hospital mortality may be interpreted as an indicator of improved quality of care. Ideally all in-hospital mortalities should be predated by CCT exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Published
2024
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47. Size and SUV max define the contribution of nodal metastases to PSA in oligorecurrent prostate cancer.

Author

Falkenbach F, Schmalhofer ML, Tian Z, Mazzucato G, Karakiewicz PI, Graefen M, Knipper S, Budäus L, Koehler D, and Maurer T

Abstract

Background: To evaluate how prostate-specific antigen (PSA) levels decrease after removal of isolated prostate cancer (PCa) nodal metastases in relation to their diameter/volume ("PSA-density of PCa-metastases") and maximum standardized uptake value (SUV max )., Methods: A total of 83 consecutive patients with solitary nodal recurrence after radical prostatectomy who underwent prostate-specific membrane antigen-radioguided salvage surgery were retrospectively analyzed. Using multivariable linear regression models, the PSA-decrease after removal of each PCa-metastases (=PSA-contribution of each PCa-metastases) was correlated with the long axis diameter/estimated volume and the SUV max of each removed metastasis. Sizes were measured by imaging and histopathologic examination., Results: A total of 83 patients were included with a median (interquartile range [IQR]) PSA-decrease of 0.56 [0.22, 1.31] ng/mL after salvage surgery. The median [IQR] long axis diameters in imaging and histopathological examination were 8.0 [6.0, 11.0] mm and 8.4 [5.5, 11.1] mm, respectively. The median [IQR] estimated volumes were 0.13 [0.05, 0.32] cc (imaging) and 0.05 [0.02, 0.17] cc (pathology). In multivariable linear regression analyses, the estimated PSA-contribution ([95% confidence interval [CI]) of each millimeter of long axis diameter was 0.09 [0.03, 0.14] ng/mL (imaging) or 0.08 [0.03, 0.12] ng/mL (histology). The minimum diameter for biochemical recurrence (PSA ≥ 0.2 ng/mL) was >2.2 mm (imaging) or >2.5 mm (histology). The estimated PSA-contribution [95% CI] of each cc cancer volume was 1.23 [0.51, 1.94] ng/mL (imaging) or 1.46 [0.40, 2.52] ng/mL (histology). SUV max as surrogate parameter for tissue composition was associated with increased PSA-contribution of PCa-metastases (+0.03-0.05 ng/mL per unit increase)., Conclusions: The diameter/volume and SUV max of metastatic tissue correlate with its contribution to PSA levels. Therefore, very small metastases may produce too little PSA for biochemical recurrence., (© 2024 The Author(s). The Prostate published by Wiley Periodicals LLC.)

Published
2024
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48. Perioperative Complications and In-Hospital Mortality in Paraplegic Radical Cystectomy Patients.

Author

Di Bello F, Siech C, de Angelis M, Rodriguez Peñaranda N, Tian Z, Goyal JA, Collà Ruvolo C, Califano G, Creta M, Saad F, Shariat SF, Briganti A, Chun FKH, Micali S, Longo N, and Karakiewicz PI

Abstract

Objective: The aim of this study was to test for the association between paraplegia and perioperative complications as well as in-hospital mortality after radical cystectomy (RC) for non-metastatic bladder cancer., Methods: Perioperative complications and in-hospital mortality were tabulated in RC patients with or without paraplegia in the National Inpatient Sample (2000-2019)., Results: Of 25,527 RC patients, 185 (0.7%) were paraplegic. Paraplegic RC patients were younger (≤70 years of age; 75 vs. 53%), more frequently female (28 vs. 19%), and more frequently harbored Charlson Comorbidity Index ≥3 (56 vs. 18%). Of paraplegic vs. non-paraplegic RC patients, 141 versus 15,112 (76 vs. 60%) experienced overall complications, 38 versus 2794 (21 vs. 11%) pulmonary complications, 36 versus 3525 (19 vs. 14%) genitourinary complications, 33 versus 3087 (18 vs. 12%) intraoperative complications, 21 versus 1035 (11 vs. 4%) infections, and 17 versus 1343 (9 vs. 5%) wound complications, while 62 versus 6267 (34 vs. 25%) received blood transfusions, 47 versus 3044 (25 vs. 12%) received critical care therapy (CCT), and intrahospital mortality was recorded in 13 versus 456 (7.0 vs. 1.8%) patients. In multivariable logistic regression models, paraplegic status independently predicted higher overall CCT use (odds ratio [OR] 2.1, p < 0.001) as well as fourfold higher in-hospital mortality (p < 0.001), higher infection rate (OR 2.5, p < 0.001), higher blood transfusion rate (OR 1.45, p = 0.009), and higher intraoperative (OR 1.56, p = 0.02), wound (OR 1.89, p = 0.01), and pulmonary (OR 1.72, p = 0.004) complication rates., Conclusion: Paraplegic patients contemplating RC should be counseled about fourfold higher risk of in-hospital mortality and higher rates of other untoward effects., (© 2024. The Author(s).)

Published
2024
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49. The efficacy of adjuvant mitotane therapy and radiotherapy following adrenalectomy in patients with adrenocortical carcinoma: A systematic review and meta-analysis.

Author

Tsuboi I, Kardoust Parizi M, Matsukawa A, Mancon S, Miszczyk M, Schulz RJ, Fazekas T, Cadenar A, Laukhtina E, Kawada T, Katayama S, Iwata T, Bekku K, Wada K, Remzi M, Karakiewicz PI, Araki M, and Shariat SF

Abstract

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with a high recurrence rate after surgical therapy with curative intent. Adjuvant radiotherapy (RT) and mitotane therapy have been proposed as options following the adrenalectomy. However, the efficacy of adjuvant RT or mitotane therapy remains controversial. We aimed to evaluate the efficacy of adjuvant therapy in patients who underwent adrenalectomy for localised ACC. The PubMed, Scopus, and Web of Science databases were queried on March 2024 for studies evaluating adjuvant therapies in patients treated with surgery for localized ACC (PROSPERO: CRD42024512849). The endpoints of interest were overall survival (OS) and recurrence-free survival (RFS). Hazard ratios (HR) with 95% confidence intervals (95%CI) were pooled in a random-effects model meta-analysis. One randomized controlled trial (n = 91) and eleven retrospective studies (n = 4,515) were included. Adjuvant mitotane therapy was associated with improved RFS (HR: 0.63, 95%CI: 0.44-0.92, p = 0.016), while adjuvant RT did not reach conventional levels of statistical significance (HR:0.79, 95%CI:0.58-1.06, p = 0.11). Conversely, Adjuvant RT was associated with improved OS (HR:0.69, 95%CI:0.58-0.83, p<0.001), whereas adjuvant mitotane did not (HR: 0.76, 95%CI: 0.57-1.02, p = 0.07). In the subgroup analyses, adjuvant mitotane was associated with better OS (HR:0.46, 95%CI: 0.30-0.69, p < 0.001) and RFS (HR:0.56, 95%CI: 0.32-0.98, p = 0.04) in patients with negative surgical margin. Both adjuvant RT and mitotane were found to be associated with improved oncologic outcomes in patients treated with adrenalectomy for localised ACC. While adjuvant RT significantly improved OS in general population, mitotane appears as an especially promising treatment option in patients with negative surgical margin. These data can support the shared decision-making process, better understanding of the risks, benefits, and effectiveness of these therapies is still needed to guide tailored management of each individual patient., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Published
2024
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